u- 

* 


/ 


UNIVERSITY  OF  CALIFORNIA 
CALIFORNIA  COLLEGE  OF  MEDICINE 


JUL241975 

WINE,  CAUfOftNIA  92664 


USE  A  HAMMER  ON  SPINAL 

COLUMN  TO  CURE  ORGANS 


Tack  Driver  Used  at  Philadelphia  Hospital  to    Overcome    Lung, 
Heart  and  Other  Troubles 


SCIENTIFIC    hammering    of    certain 
vertebrae    of    the    spinal    column 
with    an    ordinary    tack    hammer 
has  brought  relief  to  scores  of  patients 
at   the   Philadelphia  Hospital   suffering 
with    lung,    heart,    stomach    and    liver 
troubles.     The  novel  treatment  is  being 
applied  at  the  institution  with  remark- 
able success  almost  daily  by  Dr.  Myer 
Soils  Cohen,  of  4102  Girard  avenue. 

If  you  'have  lung  trouble,  and  it  ia 
essential  to  have  a  contraction  of  those 
important  organs,  wonders  can  be  worked 
in  that  direction  by  a  little  intelligent 
pounding  of  your  fourth  and  fifth  cervical 
vertebrae,  Doctor  Cohen  ho>s. 

If  your  liver  is  out  of  kilter,  a  few 
well  directed  thumps  on  the  eleventh 
dorsal  vertebrae  will  aid  greatly  in  re- 
storing the  organs  to  their  normal  condi- 
tion. Many  patients  who  h;|d  given  up 
hope  until  they  were  hammered  can 
testify  to  it. 

The  "tack  hammer  treatment1'  bears 
the  scientific  name  of  "Spondylc-therapy." 
It  was  discovered  by  Dr.  Albert  Abrams, 
a  noted  nerve  specialist  of  San  Fran- 
cisco. Recently  Doctor  Abrams  demon- 
strated his  discovery  at  the  PhiLadelphda 
Hospital  with  the  X-ray.  Since  Doctor 
Abrams'  clinic,  several  leading  Philadel- 
phia vhysicians,  including  Doctor  Cohen, 
have  applied  the  treatment. 

"Spondylotherapy,"  acording  to  Doctor 
Cohen  ds  based  upon  a  sensible  and 
scientific  understanding  of  the  various 
nerve  centers  that  gather  about  the 
spinal  cord.  Nerve  centers  that  control 
the  hearfc  the  stomach,  the  lungs,  liver 
and  spleen  are  all  found  in  the  spinal 
canal. 

The  vertabrae  of  the  spinal  columr 
serve  as  sort  of  guide  posts  in  the  loca- 
tion of  the  nerve  centers.  When  these 
vertabrae  are  struck  with  a  hamme* 
they  cause  a  vibration  of  the  nerves  am 
a  reflex  action  is  produced  on  the  organ 
!  which  the  physician  is  attempting  to 
treat." 

"  'Spondylotlierapy,'  "  said  Doctor 
Cohen,  "is  not  so  much  for  the  treat- 
ment of  disease  as  it  is  for  the  treat- 
ment of  the  condition  of  the  various  in- 
ternal organs  of  the  body. 


"I  was  present  at  Doctor  Abram»' 
demonstration  in  this  city  and  was  as- 
tonished at  the  result.  The  subject  was 
placed  under  the  X-ray  so  that  the  effect 
on  the  various  organs  could  be  observed 
plainly. 

"For  instance  if  a  patient  has  a  di- 
lated heart,  the  organ  can  be  contracted 
by  the  hammering  of  a  certain  vertebrae 
which  is  in  proximity  to  the  nerves  that 
control  that  organ.  A  patient  suffering 
with  asthma  or  a  spasm  of  the  bronchial 
tubes  can  be  greatly  helped  by  thumping 
the  vertebrae  nearest  the  nerve  center 
that  controls  th  bronchial  tubes.  The 
thumping  causes  a  reflex  action  and!  con- 
tracts the  tubes. 

"Some  physicians  who  have  adoptd  the 
new  treatment  use  a  pounding  instru- 
ment called  a  "plessor,"  but  I  use  an  or- 
dinary tack  hammer  with  the  head  cov- 
ered with  rubber. 

"Xow,  if  I  wish  to  contract  the  heart 
of  a  patient,  I  hammer  the  seventh  cervi- 
cal vertebrae.  That  produces  a  reflex 
action  on  the  organ  and  brings  the  de- 
sired result  almost  immediately.  If  it  is 
necessary  to  dilate  the  heart,  I  pound 
with  my  hammer  on  the  spinal  column 
from  the  eighth  to  the  twelfth  dorsal 
vertebrae.  The  treatment  rarely  fails. 

"To  contract  'the  lungs  I  thump  the 
fourth  and  fifth  cervical  vertebrae,  and 
to  dilate  the  lungs  I  do  a  little  sharp 
hammering  from  the  third  to  the 
eighth  dorsal  vertigrae. 

"To  contract  the  stomach,  liver  and 
spleen,  it  is  necessary  to  gently  pound 
the  first  and  third  lumbar  vertebrae. 
To  dilate  those  01  grans  I  pound  the 
eleventh  dorsal  vertebrae. 

"The  treatment  seema  even  arore  won- 
derful when  it  is  .demonstrated  under  the 
X-ray.  When  Doctor  Abraras  gave  hi& 
clinic  I  could  see  the  heart  a;Jjd  the  arota, 
the  largest  blod  vessel  coming  from  the 
heart  of  the  subject,  contracting  when 
Doctor  Abrams  hammered  the.  seventh 
ervical  vertebrae. 

"It  is  safe  to  say  that  'Spondylotherapy' 
is  yet  in  its  Infancy  and  that  we  may  ex- 
pect more  wonderful  results  from  the 
treatment  in  the  future.  The  relief  it 
has  given  patients  at  he  Philadelphia 
Hospital  has  convinced  me  of  its  scien- 
tific value." 


Spondylo  therapy 


BY  THE  SAME  AUTHOR 

NEW  CONCEPTS  IN  DIAGNOSIS  AND  TREATMENT;  Physico-Clinical  Medi- 
cine, 1916— The  practical  application  of  the  Electronic  Theory  in  the  inter- 
pretation and  treatment  of  disease.  The  author  is  sponsor  for  the 
visceral  reflexes  bearing  his  name  and  is  the  originator  of  methods  in 
which  reflexes  are  utilized  in  diagnosis. 

"It  is  an  erudite,  elaborate  study  of  new  conceptions" — "and  the  applica- 
tion of  physico-clinical  facts  to  human  considerations  and  needs." — The 
British  Journal  of  Tuberculosis. 

SPONDYLOTHERAPY  ;  Physio  and  Pharmacotherapy  and  Diagnostic  meth- 
ods based  on  a  study  of  what  the  author  has  first  called  Clinical  Physiol- 
ogy— Sixth  Edition,  1913. 

"The  author  gives  evidence  of  high  scholarly  attainments"— "The  result 
is  a  treatise  of  extraordinary  interest  and  usefulness." — New  York  Medical 
Journal,  May  8,  1912. 

PHYSICO-CLINICAL  MEDICINE;  A  Quarterly  Journal  devoted  to  the  study 
of  the  Electronic  Reactions  of  Abrams  and  the  Visceral'  Reflexes  of 
Abrams,  in  the  diagnosis,  treatment  and  pathology  of  disease.  All  ad- 
vances made  in  electronic  medicine  and  spondylotherapy  are  reported  in 
this  Journal. — Philopolis  Press,  2135  Sacramento  Street,  San  Francisco. 

CLINICAL  DIAGNOSIS  ;  Fourth  Edition. 

AUTO- INTOXICATION;  Causes,  symptoms  and  treatment. 

SPLANCHNIC  NEURASTHENIA  (The  blues)  ;  Fourth  Edition.  The  author 
was  the  originator  of  this  neologism,  describing  this  variety  of  neuras- 
thenia. 

"It  is  a  long  time  since  we  have  read  a  medical  book  with  such  interest 
and  real  enjoyment." — Medical  Record. 

TRANSACTIONS  OF  THE  ANTISEPTIC  CLUB — E.  B.  Treat  &  Co.,  New  York. 

DIAGNOSTIC  THERAPEUTICS;  A  pioneer  work  dealing  with  drugs  and 
remedial  measures  in  the  diagnosis  of  disease.  Rebman  Co.,  New  York. 

"Dr.  Abraras  has  produced  a  book  along  new  lines,  a  thoughtful  philo- 
sophical exposition  of  a  much  neglected  subject.  The  text  is  presented  in 
plain,  charming  English  and  deals  with  a  unique  aspect  of  medicine."- 
Maryland  Medical  Journal. 

SCATTERED  LEAVES  FROM  A  PHYSICIAN'S  DIARY. 

DISEASES  OF  THE  LUNGS  AND  PLEURA — Fortnightly  Press  Co.,  St.  Louis. 

NERVOUS  BREAKDOWN. 

CONSUMPTION. 

DOMESTIC  AND  PERSONAL  HYGIENE;  Cohen's  System  of  Physiologic 
Therapeutics. — >P.  Blakiston's  'Son  and  Co. 

ELECTRONIC  REACTONS  OF  ABRAMS;  International  Clinics,  Vol.  1,  27th 
series. — J.  B.  Lippincott  Co. 

SPONDYLOTHERAPY;  Reference  Handbook  of  the  Medical  Sciences,  Vol. 
vii,  3rd  edition. — Wm.  Wood  and  Co. 


PREFACE  TO  THE  SIXTH  EDITION 

*T»  HE  visceral  reflexes  of  ABRAMS  have  been  firmly  entrenched 
*  in  medical  literature  and,  respecting  Spondylotherapy,  the  re- 
port of  the  committee  on  Standardizaton  of  the  American  Electro- 
Therapeutic  Association,  is  as  follows : 

"In  Spondylotherapy.  the  employment  of  mechanical 
vibration  fills  one  of  the  most  useful  roles  in  therapeutics. 
It  is  easily  controlled  and  is  practical  and  effective  of 
application  in  the  hands  of  those  familiar  with  the  meth- 
ods of  employing  it  as  spinal  percussion." 

Incorporated  in  the  present  edition  are  chapters  on,  The  Elec- 
tronic Reactions  of  Abrams  reprinted  with  additions  from  "Inter- 
national Clinics,"  and  a  summary  of  Spondylotherapy,  which  is 
reprinted  from  "Reference  Handbook  of  the  Medical  Sciences" 
(3d  edition). 

This  work  on  Spondylotherapy  has  been  translated  into  the 
French  and  Japanese  languages.  In  Spondylotherapy,  1914  (page 
96  et.  seq.),  the  polarity  of  the  reactions  should  be  reversed  as  fol- 
lows: 

Positive  should  read  negative  and  negative  should  read  positive. 
Neutral,  and  positive  and  negative  reactions,  are  correct. 

These  reactions  only  hold  when  a  male  subject  is  used  and 
who  during  the  time  of  the  examination  faces  the  west. 

A.  A. 

2135  SACRAMENTO  STREET, 
SAN  FRANCISCO,  CAL. 
FEBRUARY,  1918. 


tSPONDYLOTHERAPY 


~7 


PHYSIO  AND  PHARMACO-THERAPY  AND 

DIAGNOSTIC    METHODS    BASED 

ON  A  STUDY  OF 

CLINICAL    PHYSIOLOGY 


BY 


ALBERT  ABRAMS,  A.M.,  LL.D.,  M.D. 

DR.  MED.  (HEIDELBERG),  F.  R.  M.  S.,  (LONDON). 

HONORARY    PRESIDENT    OF    THE    AMERICAN    ASSOCIATION    FOR 
THE  STUDY  OF  SPONDYLOTHERAPY;  FORMERLY   PROFESSOR 
OF   PATHOLOGY   AND   DIRECTOR    OF   THE   MEDICAL    CLINIC 
COOPER  MEDICAL  COLLEGE    (DEPARTMENT  OF  MEDICINE, 
LELAND    STANFORD    JUNIOR    UNIVERSITY);    CONSULT- 
ING   PHYSICIAN    TO    THE    MOUNT   ZION   AND    FRENCH 
HOSPITALS,    SAN    FRANCISCO;    PRESIDENT    OF    THE 
EMANUEL   SISTERHOOD    POLYCLINIC;    PRESIDENT 
OF   THE   SAN   FRANCISCO   MEDICO-CHIRURGICAL 
SOCIETY;    PRESIDENT    OF   THE   ALUMNI   ASSO- 
CIATION   OF    COOPER    MEDICAL   COLLEGE; 
FELLQW    OF    THE    AMERICAN    MEDICAL 
ASSOCIATION,   ETC. 


SIXTH    EDITION 


PHILOPOLIS  PRESS 

2135  SACRAMENTO  STREET, 

SAN  FRANCISCO,  CAL. 

1918. 


(Us 


Copyright,  ipro 

by 
Albert  Abrams 


Copyright,  1912 

by 
Albert  Abrams 


Copyright,  1918 

by 
Albert  Abrams 


TO   THE   MEMBERS 

OF  THE   FACULTY   OF   MEDICINE,   PARIS, 

IN    RECOGNITION   OF  THEIR   DISTINGUISHED   SERVICES 

IN   THE   ADVANCEMENT   OF   MEDICINE   AND 

FOR   MANY   ACTS   OF   COURTESY 

THIS  BOOK  IS  DEDICATED 

BY  THE  AUTHOR 


PREFACE  TO  THE  FIFTH  EDITION 

THIS  represents  the  fifth  edition  of  Spondylotherapy,  the  first 
edition  of  which  was  published  in  1910.  This  edition  has 
been  enlarged  to  include  Progressive  Spondylotherapy  for  the  years  1913 
and  1914  and  an  address,  Human  Energy.  The  author  ventures  to 
hope  that  his  new  physico-clinical  methods  which  appear  in  the 
latter  address  may  be  the  means  of  attaining  greater  precision  in 
diagnosis. 

A  translation  of  this  work  into  French  is  now  in  the  course  of 
preparation. 

A.  A. 

291  GEARY  STREET, 
SAN  FRANCISCO,  CAL., 
JANUARY,  1914. 


Preface  to  the  First  Edition 

THE  subject  of  spinal  therapeutics  has  received  less  attention 
from  the  medical  profession  than  it  deserves.  Even  the  laity 
know  that  cold  applied  to  the  back  of  the  neck  may  arrest  hemorrhage 
from  the  nose,  and  that  heat  applied  to  the  small  of  the  back  may 
hasten  menstruation.  The  profound  and  far-reaching  physiologic 
truths  which  underlie  these  simple  phenomena  have  either  been 
ignored  or  only  given  inconsiderate  attention. 

Others,  less  scientific  but  more  astute,  have  determined  empiric- 
ally that  manipulation  of  the  spine  does  sometimes  cure  conditions 
that  have  failed  of  cure  in  the  hands  of  experienced  physicians. 
So  it  has  come  to  pass  that  schools  of  practice  exploiting  spinal  man- 
ipulation as  a  cure-all  have  arisen.  Neifher  the  fury  of  tongue  nor 
the  truculence  of  pen  can  gainsay  the  confidence  which  these  systems 
of  practice  have  inspired  in  the  community. 

The  author  was  led  to  a  deeper  study  of  spinal  therapeutics  in 
investigating  various  visceral  reflexes  which  bear  his  name.  As  the 
years  passed  on,  he  ascertained  that  a  number  of  pathologic  con- 
ditions could  be  more  easily  and  certainly  controlled  by  spondylo- 
therapeutic  means,  than  by  the  conventional  measures. 

Some  physicians  may  consider  the  remedial  methods  discussed 
in  this  book  to  be  unduly  and  unworthily  simple,  on  the  principle 
that  what  is  obvious  can  hardly  compete  with  what  is  obscure  in 
the  treatment  of  disease.  The  most  mystifying  phenomena  rest  upon 
the  least  complex  causes;  and  the  simpler  a  thing  is,  the  harder  it  is 
to  understand. 

Anybody,  however,  who  investigates  the  study  of  spinal  thera- 
peutics in  earnest,  will  discover  that  the  simplicity  is  only  apparent. 
The  successful  practice  of  spondylotherapy  requires  knowledge, 
observation  and  experience  of  the  highest  kind,  and  is  comparable 
to  the  best  effort  in  any  other  department  of  scientific  medicine. 
Indeed,  one  of  the  author's  truest  motives  has  been  to  lift  this  whole 
subject  of  spinal  therapy  out  of  the  low  state  in  which  it  blunders 
onward,  hitting  or  missing  as  the  case  may  be,  and  rescuing  it  from 
the  lowly  esteem  which  physicians  as  a  class  have  thus  felt  for  it. 
He  has  endeavored  to  put  it  in  a  place  befitting  its  scientific  impor- 
tance, and  to  emphasize  its  great  practical  helpfulness  in  disease. 

VII 


P  r  e  fa  c  e     to    the    First    Edition 

Any  method  of  cure  that  is  more  or  less  new  is  inclined  to  be 
viewed  critically  by  the  formalist  and  traditionalist,  and  so  it  should 
be.  The  writer  knows  better  than  any  one  else  can  the  incompleteness 
and  imperfections  of  his  work.  It  is  really  a  pioneer  effort  and  he 
only  asks  that  it  be  judged  as  such.  Indeed,  the  author  hopes  to 
receive  many  suggestions  and  if  need  be,  corrections,  and  to  profit 
by  them. 

One  word  concerning  the  cases  cited  in  illustration  of  the  methods 
which  the  author  has  described  in  various  parts  of  the  book.  These 
may  seem  more  or  less  incredible,  the  outcome  of  enthusiasm,  bias, 
of  some  defect  of  the  power  of  scientific  observation,  or  of  judgment. 
Yet  the  cases  cited  are  not  the  most  remarkable  that  the  author  has 
encountered  in  his  practice.  Some  of  these  cases  have  been  deliber- 
ately suppressed  with  a  feeling  that  many  readers  are  hardly  prepared 
to  appreciate  or  to  credit  the  results  which  may  be  achieved  by  an 
earnest  study  and  practice  of  spondylotherapy.  To  eschew  a  remedy 
because  we  cannot  gauge  its  material  properties  may  be  an  act  worthy 
of  the  scientist,  but  the  aim  of  the  physician  is  to  cure  disease.  In 
the  presence  of  a  sick  man,  two  questions  are  to  be  answered:  "What 
is  the  matter  with  him,  and  what  will  do  him  good?"  Neither  the 
pragmatical  doctrinaire  who  accepts  nothing  but  what  is  demonstrated 
morphologically,  nor  the  representative  of  an  exclusive  system  of 
practice,  with  his  introspective  reasoning,  can  aid  therapeutics.  The 
former  forgets  that  the  crucial  test  for  the  action  of  remedial  measures 
is  in  their  clinical  application  and  that  many  of  our  most  potent 
drugs  have  been  inherited  from  the  therapeutic  acumen  of  our  medical 
ancestors.  "The  diseases  of  which  we  know  the  least  pathology  are 
the  diseases  which  we  treat  successfully."  Cure,  as  conceived  by 
the  introspectionist,  cannot  merit  the  imprimatur  of  the  scientist, 
and  for  this  reason,  the  author  has  endeavored  to  justify  his  con- 
clusions by  demonstrable  evidence. 

ALBERT  ABRAMS. 
246  POWELL  STREET, 
SAN  FRANCISCO,  CAL., 
JANUARY,  1910. 


vin 


Preface  to  the  Third  Edition 

THE   favorable   reception    accorded    to    the    previous   editions, 
has  induced  the  author  to  undertake  the  enlargement  of  this 
work  by  the  addition  of  seven  chapters  (xii — xviii)   and  fifty  new 
illustrations. 

When  the  first  edition  of  this  book  was  published,  nearly  two  years 
ago,  it  was  a  pioneer  effort  and  only  the  cognoscenti  could  correctly 
interpret  its  real  significance,  viz.,  that  spondylotherapy  was  suggested 
by  the  study  of  human  physiology,  on  the  principle  that,  "The  proper 
study  of  mankind  is  man."  After  this  manner,  clinical  physiology 
is  made  the  basis  of  clinical  pathology.  To  launch  an  innovation 
in  medicine,  with  its  surfeit  of  theories  and  theorists,  is  fraught  with 
much  risk  to  the  innovator  and  the  author  anticipated  the  usual  fate 
accorded  to  the  originator,  viz.,  condemnation,  discussion  and  possibly 
acceptance.  Neither  fear  of  difficulty,  nor  adverse  criticism,  deterred 
him  from  regarding  scepticism  as  an  argument  against  the  truth  of 
his  observations. 

It  is  indeed  unfortunate  that  our  medical  journals  have  not  yet 
attained  that  Utopian  condition,  when  they  are  eager  to  give  space 
to  the  protestations  of  an  author,  who  feels  that  his  work  has  been 
misinterpreted  or  unjustly  criticised.  For  the  latter  reason,  the 
author  may  be  pardoned  for  utilizing  the  bulk  of  this  preface  in 
refuting  some  reviews  of  the  previous  edition.  The  review  of  "The 
Journal  of  the  American  Medical  Association,"  is  discussed  on  page 
387.  Occasionally,  a  reviewer  has  sat  in  the  scorner's  seat  and 
hurled  the  cynic's  ban.  "There  is  a  principle  which  is  a  bar  against 
all  information,  which  is  proof  against  all  argument  and  which  cannot 
fail  to  keep  a  man  in  everlasting  ignorance  ;  this  principle  is  con- 
tempt prior  to  examination." 

A  reviewer  asseverated  that  the  book  contained  nothing  that  was 
particularly  new.  The  latter  conflicted  with  another  reviewer  who 
said,  "There  are  fifty  pages  scattered  throughout  the  volume,  any  one 
of  which  could  be  torn  out  and  be  used  as  a  starting  point  and  an  in- 
spiration for  most  valuable  research  work.  The  possessor  of  this  book 
has  a  rich  mine  of  startlingly  suggestive  knowledge  ....  and 
to  the  man  of  study  who  strives  to  reach  ever  better  and  more  fruitful 

IX 


Preface    to    Third    Edition 

methods  of  investigation  and,  cure  of  disease,  this  book  will  be  most 
•welcome" 

In  another  publication  a  prominent  surgeon  commented  as  follows: 
"Probably  the  most  startlingly  radical  stand  ever  taken  within  the 
ranks  of  the  medical  profession  was  that  announced  this  very  year  by 
DR.  ALBERT  ABRAMS,  of  San  Francisco,  in  his  remarkable  book, 
1  Spondylotherapy.''  ' 

An  eminent  French  clinician,  in  commenting  on  "Spondylotherapy," 
says:  "Some  of  my  results  and  those  of  my  colleagues  in  Paris,  by  the 
methods  of  Spondylotherapy  are  positively  miracles.11 

Those  "in.  authority"?  who  regard  innovation  from  the  view- 
point of  heresy,  recalls  the  ban  mot  by  a  witty  compatriot  of  Talley- 
rand, who,  in  commenting  on  the  conservatism  of  the  latter  said,  if 
Talleyrand,  had  been  present  at  the  creation  he  would  have  exclaimed: 
"Good  gracious!  Chaos  will  be  destroyed." 

"He  who  dreads  new  remedies  must  abide  old  evils." 

Yet  another  reviewer  who  questioned  the  right  of  a  clinician  to 
digress  from  traditional  methods  in  the  investigation  of  facts  physio- 
logic, must  be  answered.  It  is  not  now  unusual  for  the  laboratory- 
physiologist,  to  preside  at  the  birth  of  his  theory  one  day,  and  for  the 
clinicist  to  officiate  at  its  burial  on  the  morrow.  Pavloff  observes, 
"The  physician  gives  a  more  correct  verdict  concerning  physiologic 
processes  than  the  physiologist  himself."  Hughlings  Jackson,  was 
one  of  the  greatest  scientific  neurologists,  yet  he  never  performed  an 
experiment  but  formulated  his  conclusions  in  the  wards  of  a  hospital. 
Some  of  his  enthusiastic  proselytes  have  arrogated  to  the  author 
the  questionable  honor  of  having  created  a  new  system  of  medical 
practice.  No  system  can  exclusively  preempt  the  field  of  thera- 
peutics, which  is  a  composite  practice  founded  on  empiricism  and 
the  practical  application  of  pharmacology  and  other  sciences  in  the 
treatment  of  disease  and  the  innovationist  must  create  no  discon- 
tinuity in  the  transition  to  new  knowledge.  As  an  emphatic  protest 
to  such  an  assumption,  ^the  author  has  incorporated  many  facts 
relating  to  the  employment  of  drugs  in  the  treatment  of  disease 
and  refers  to  his  monograph,  "Diagnostic-Therapeutics."  When 
the  author  employed  the  neologism,  Spondylotherapy  (G.  Spondylos, 
vertebra  +  therapeia,  treatment),  he  advocated  no  exclusive 
methods  in  spinal  therapeutics,  but  employed  all  the  resources  of 


Preface    to    Third    Edition 

scientific  medicine  bearing  on  the  treatment  of  disease.  Since  the 
publication  of  his  work,  the  author  regrets  that,  some  so-called  "drug- 
less  healers"  are  exploiting  the  term  spondylotherapy  to  abet  their 
exclusive  methods  of  practice.  For  the  benefit  of  physicians  who 
cannot  master  some  of  the  details  of  spondylotherapy,  a  practical 
course  is  given  on  this  subject  by  the  author  from  time  to  time. 

ALBERT    ABRAMS. 
246  POWELL  STREET, 
SAN  FRANCISCO,  CAL., 
FEBRUARY    1912. 


Contents 

CHAPTER  I. 

HISTORICAL. 

Page 

Primitive  Era  of  Spondylotherapeutics  .             .  i 

The  Griffin  Brothers             .....  2 

Swedish  Gymnasts         .             .             .             .             .  .  .     4 

Osteopathy             .             .             rV            ...  4 

Chiropractic       .             .             .             .             .             .  .5 

Dana            .             .             .             .             .             .             .  7 

Quincke             .             .             .             .             .             .  .7 

Head            .......  7 

The  Vertebral  Reflexes               .             .             .             .  .7 


CHAPTER  II. 

ANATOMIC,  TOPOGRAPHIC  AND  PHYSIOLOGIC  DATA. 

Structure  of  the  Spinal  Cord      .             .             .            i.  1 7 

Roots  and  Distribution  of  the  Spinal  Nerves         '"  .             »  '  18 

Anatomic  Landmarks    .             .             .                        ~U  19 

Sympathetic  System              .             *             *             .             -  24 

Physiology  of  the  Spinal  Cord   .             .             .             .  .26 
Localization  of  the  Functions  in  Different  Segments  of  the  Spinal 

Cord     .......  30 


CHAPTER  III. 

SYMPTOMATOLOGY. 

Examination  of  the  Back           .             .  .             .  -38 

The  Normal  Spine               .  .             .  38 

Spondylography              .             .             .  -             •  .42 

Examination  of  the  Muscles  of  the  Back  ...  46 

Stiff  Back          .  .  .  -  •  •    '         •     5° 

• 

Muscular  Hypotonia  .  .  .  .  •  52 

XIII 


C         o          n          t  e          n  t          s 

Page 

Pain  and  Tenderness  of  the  Spine          .            .  .  -55 

Sympathetic  Sensations        .             .             .  .  -57 

Dermatomes  of  Head     .             .             .             .  ,  58 

Vertebral  Pain         .            .            .            .  .  .           66 

Vertebral  Tenderness     .             .  .            .  .             •     71 

Vertebral  Percussion            .             .             .  .  .79 

Vibrosuppression            .             .  ...  .             .80 


CHAPTER  IV. 

SUMMARY  OF  SPINAL  DISEASES  AND  SYMPTOMS. 

Backache           .             .            «            .             .             .  .     83 

Chest  Deformities    .             .             .             .             .  .            94 

Coccygodynia    -            ,            .            ...             .  -95 

Faulty  Attitudes      .            .            .            .  96 

Litigation  Backs             .             .                          .             .  -97 

Lumbago     .......  99 

Neurotic  Spine                .             .             .             .             .  .   103 

Osteo- Arthritis         i             .             .             .             .  .          105 

Pott's  Disease  of  the  Spine         .....   108 

Sacro- Iliac  Disease    .          .             .            .            .  .in 

Sacro- Iliac  Relaxation   .            .            .            .             .  .in 

Spinal  Curvatures    .             .            .            .             .  .113 

Scoliosis             .             .             .             .             .             .  •   iJ3 

Kyphosis  and  Lordosis         .             .           .              .  .115 

Angular  Curvature         .             .             .             .             .  .   117 

Spondylitis    .......          117 

Spondylolisthesis            .            .            .            .             .  .118 

Traumatism  of  the  Spine     .             .            .             .  .          118 

Tumors  of  the  Spine      .             .             .             .             .  .121 

Typhoid  Spine         .             .             .             .             .  .121 

Vertebral  Insufficiency  .             .            .            .            .  .122 

Diagnosis  of  Spinal  Diseases            .            .            .  .126 

Pains     .             .             .             .             .             .             .  .128 

Deformity    ....  ...          131 

Compression  of  the  Spinal  Cord             .            .            .  .   133 

xiv 


C          o          n          t          e          n          t          s 

Page 
Paraplegia  .  .  .  .  .  .134 

Tuberculosis      .  .  .  .  .  .  -I37 

Syphilis        .  .  .  .  .  .  .          139 

Gonorrhoea        .......  141 

Rheumatisin  ......          141 

Rickets  .......   143 

Spinal  Meningitis  -.  .  .  .  .  .144 


CHAPTER  V. 

GENERAL  SPONDYLOTHERAPY. 

Abdominal  Supporters  .             .             .  .             .             -145 

Acupuncture            .             .             .  .             .             .146 

Counter-irritation  ......  148 

Electrotherapy         .             .          .  .  '.            .             .          151 

Exercises            .             .             .             .  .             .             .   159 

Re-education  of  Co-ordinated  Movements  .             .             .          165 

Spinal  Hydro-Therapy  .             .            .  .             .             .   166 

Lumbar  Puncture    .             .             .  .             .             .167 

Massage             .             .            .            .  •            .  168 

Psychrotherapy        .             „             .  .             .             .172 

Thermotherapy              .             .             .  .            .            .   174 

Vibratory  Massage               .             .  .            .             ..        175 


CHAPTER  VI. 

PSEUDO-VISCERAL  DISEASES. 

Neuralgia  ......  ..182 

Intercostal  Neuralgia  .  .  .  .  .186 

Differential  Diagnosis    ......   189 

Pseudo-Appendicitis  .....          191 

Pseud  o- Cerebral  Disease  .  .  .  .  .192 

Pseudo-Angina  Pectoris        .  .  ~  .  .194 

Pseudo- Arrhythmia        .  .  .  .  .  .   195 

Pseudo-Esophagismus          .  .  .  .  .196 

XV 


O          o          n          t          e  n  t          s 

Page 
Pseud o-Nephrolithiasis  .  .  .  .  .  .   197 

Pseudo-Dyspepsia    .  .  .  .  .  .197 

Pseudo-Cholelithiasis     .......  197 

Pseudo-Mammary  Neoplasms          .  .  .  .198 


CHAPTER  VII. 

THE   CIRCULATORY  SYSTEM. 

The  Heart  Reflex          .  .  .  .  .  -  199 

Cardiac  Sufficiency  .  .  .  .  .210 

Differential  Table  of  Asthma     .  .  .  .  .212 

Tests  for  Heart  Sufficiency  .  .  .  .  .215 

Angina  Pectoris  .  .  .  .  .  .221 

The  Heart  Reflex  of  Dilatation        .  .  .  ,          221 

Differential  Table  of  True  and  False  Angina     .  .  .224 

Functional  Affections  of  the  Heart  .  .  .  .228 

Inhibition  of  the  Heart  .....   228 

Physiology  and  Pathology  of  the  Blood-Vessels         .  .          231 

Blood-Pressure  .......   234 

Vaso-Motor  Factor  in  Blood-Pressure  .  .  .          239 

Sphygmomanometry       ......   244 

Hypertension  and  Hypotension         ....          246 

The  Aortic  Reflexes       .  .  .  .  .  .   254 

Aneurysm  of  the  Thoracic  Aorta      .  .  .  .254 

The  Vaso-Motor  Apparatus       .  .  .  .  .272 

Vaso-Motor  Neuroses  .  .  .  .  .275 


CHAPTER  VIII. 

THE   RESPIRATORY  APPARATUS. 

Physiology          .......   288 

Histology       .......          289 

Postural  Lung-Dullness  .  .  .  .290 

Lung  Reflex  of  Dilatation    .  .  294 

Lung  Reflex  of  Contraction       .....  298 

xvi 


c 


n          t          e  n 


Page 
Pulmonary  Atelectasis          .....          299 

Bronchial  Asthma  .  ,>  ....   303 

Spasmodic  Bronchostenosis  .  .  .  311 

Tuberculosis  .  .  .  .  .  .   315 

Hemoptysis  .  .  .  .  .  315 


CHAPTER  IX. 

THE   DIGESTIVE   SYSTEM. 

The  Stomach     .  .         .  "* '.  ?  .  .  .  .   316 

The  Stomach  Reflexes          .  ;  ,  .  .          316 

Percussion  of  the  Stomach          .  .  .  .  .   321 

Treatment  of  Diseases  of  the  Stomach          .  .  .324 

The  Intestine     .  .  .  c  .  .  .  325 

The  Intestinal  Reflexes         .  .  .  .  .325 

Diseases  of  the  Intestines  .  .  .  .  .   326 

Treatment  of  Constipation  .  'V  .  .  .          329 

The  Intestinal  Neuroses  .....   330 

The  Liver   .  .  ..  .  .  .  .331 

Hepatic  Toxemia  ......  334 

Splanchnic  Neurasthenia      .....          345 


CHAPTER  X. 

MISCELLANEOUS   REFLEXES. 

The  Spleen        .......  351 

Reflexes  of  the  Spleen          .  .  .  m  352 

Splenic  Reflexes  in  Treatment   .....  352 

Uterus  Reflex  .  .  .  .  358 

Dysmenorrhea  .  .  .  .  .  .  -358 

The  Bladder  Reflex  .  .  .  .  .358 

The  Kidney  Reflexes     .  .  .  .  -359 

Nervous  Symptoms  .  .362 

Paralysis,  Contractures,  Ataxia  . .  .  .  .  362 

XVII 


Contents 

CHAPTER  XI. 

THE    THERAPEUTICS  AND    DIAGNOSIS    OF   PAIN. 

Page 

Segmental- Analgesia    .           .           .           .  .          .           .  366 

Concussion- Analgesia         .           .           .  .           .           .367 

Segmental-Localization            .           .           .  .           .           -367 

The  Trigeminus  Nerve      .           .           .  .           .           .         371 

Sinusoidal- Analgesia     .           .           .           .  .           .           -374 

Segmental-Psychrotherapy            .           .  .           .       '    .         375 

Segmental-Analgesia  of  the  Viscera   .           .  .           .           .  376 

Segmental- Analgesia  in  Diagnosis           .  .           .           .        377 

Physiology  of  Spondylotherapeutic  Methods  .           .           -  379 

Spinal  Nerve-Trunk  Analgesia     .           .  .           .           .382 

Cortical  Sinusoidalization       .           .           .  .           .           .  383 

CHAPTER  XII. 

THE    REFLEXES    AND    THE    PERIPHERAL    SYMPTOMATOLOGY 
OF  VISCERAL   DISEASE. 

Purport  of  Spondylotherapy    ......  387 

General  Features  of  Reflexes        .....         390 

Therapeutics  of  Reflexes         ......  392 

Therapeutics  of  Concussion          .....         394 

Comparison  of  Methods          .  .  .  .  .  397 

Trophic  Functions  of  Cord  .....         400 

Trophic  Diseases          .  .  .  .  .  ..401 

Peripheral  Reflex  Phenomena      .  .  .  .  .        411 

Insufficiency  of  the  Foot          .  .  .  .  .  .421 

Test  for  the  Splanchnic  Circulation        .  .  .  .        427 

Reflexes  of  the  Cranial  Nerves          .....  440 

CHAPTER  XIII. 

TONUS  OF  THE  VAGUS  AND  PHARMACOLOGY  OF  THE  REFLEXES. 

Tonus  of  the  Vagus      ....'...  446 

Anatomy  of  the  Vagus       ......         446 

Physiology  and  Clinical  Physiology  of  the  Vagus    .  .  .  448 

XVIII 


c 


n          t          e          n 


Diagnosis  of  Vagus-Tonus  .       /'.  '"       .  .  .  453 

Vagus-tone  and  the  Sense  Organs     ......  462 

Psychovagus  Tone  ......  466 

Methods  for  Increasing  and  Decreasing  Vagus-tone  -         .  .  469 

Therapeutic  Results  ......  474 

Diseases  Caused  by  Vagus-hypertonia  and  Vagus-hypotonia        .  479 

Phylogenetic  Diseases        .  .        '4i  .  .  .  500 

Vagal  Hyperesthesia     .......  504 

Clinical  Pharmacology       .  .  .  .  .  504 

CHAPTER  XIV. 

FURTHER   ADVANCES   IN   THE   DIAGNOSIS   AND   TREATMENT 
OF   DISEASES    OF   THE   CIRCULATORY   SYSTEM. 

Tests  For  Heart-Sufficiency    .  .  .  .  .  .510 

Kuatsu         .....        !..  .  .  515 

Heart-Failure    .  .  .  .  .  .  .  .  523 

Functional  Cardiac  Murmurs       .  .        "..-..          .  .  525 

Reflex  of  the  Pulmonary  Artery         .  .  .  .  .  526 

Inhibition  of  the  Heart      .  .  .  .  .  .  528 

Cardioptosis       .  .        '  .  .  .  .  .  .  529 

Subclavian  Murmurs         .  .  ...  —          .  533 

Angina  Pectoris  .  .  .  .  .  .  539 

Anginoid  Pains        .......  540 

Phrenic  Nerve   ........  549 

Diaphragm  Reflex  .  .  .          ".  .  550 

Aneurysm  ........  550 

Fluoroscopy  of  the  Aorta  .  .  .  .  .  .561 

CHAPTER  XV. 

FURTHER   ADVANCES   IN   THE   DIAGNOSIS    OF   DISEASES 
OF   THE   DIGESTIVE    SYSTEM. 

Percussion  of  the  Stomach      ......  584 

Diagnostic  Data      .......  588 

Percussion  of  the  Intestines     .  .  .  .  .  .  591 

The  Gall-Bladder  .  .  .  .  .  .597 

Diagnostic  Data  .......  599 

The  Pancreas          .......  600 

XIX 


Contents 

Page 
CHAPTER  XVI. 

PHYSIO-THERAPY   OF   PULMONARY  TUBERCULOSIS. 

Anemic  Theory  .......  602 

Clinical  Evidence    .......         603 

Triangles  of  Grocco      .......  606 

Methods  for  Eliciting  Lung-Hyperemia  ...         608 

Resume  .........  608 

Treatment    ........         609 

Author's  Treatment      .  .  .  .  .  .  .612 

Visceral  Vascularity  .  .  .  .  .  .614 

Blood- Volume   .  .  .  .  .  ...  .617 

CHAPTER  XVII. 

TREATMENT    OF    WHOOPING    COUGH. 

Pertussis       ........         619 

Author's  Conception  of  Pertussis       .....  620 

Author's  Treatment  ......         624 

Results  of  Treatment   .  .  ....  .  .  .  624 

Analysis  of  Treatment       .  .  .  .  .  .627 

CHAPTER  XVIII. 

MISCELLANEOUS   DATA. 

Further  Advances  in  the  Utilization  of  the  Kidney  Reflexes  .  629 
Prostatic  Hypertrophy       .           .           .           .           .           .634 

Reflexotherapy  .           .           .           .           .           .           .  .  636 

Spondylotherapy  in  the  Etiology  of  Disease       .           .           .  640 

Synoptic  Table  of  Spondylodiagnosis            .           .           .  .642 

Synoptic  Table  of  Spondylotherapy         ....  644 

Synoptic  Table  of  Pharmacology  of  the  Reflexes    .           .  .  644 

Spondylotherapeutic  Armamentarium     ....  646 

Bibliography      .           .           .           .           .           .           .  -657 

Index                                               .....  661 


xx 


Illustrations 


Figure.  Page 

1.  Illustrating  the  Chiropractor's  Conception  of  Disease  .       6 

2.  Plexor  and  Pleximeter  for  the  Vertebral  Reflexes         .  9 

3.  Concussing  the  Spines  with  the  Hands       .             .  .10 

4.  Spinal  Muscular  Reflexes         ...            .             .             .  13 

5.  Viscero-Motor  Reflexes      .  ,       L, _.{           .             .  14 

6.  Babinski  Toe-Reflex              ._  ...            .             .             .  16 

7.  Conducting  Paths  in  the  Spinal  Cord          .             .  17 

8.  A  Spinal  Nerve             .         .    f.  .          .             .             .  18 

9.  Composition  of  a  Peripheral  Nerve-Trunk               .  19 

10.  Relations  of  the  Segments  of  the  Spinal  Cord  .             .  20 

11.  Posterior  Aspect  of  the  Thorax  and  Abdomen        .  .22 

12.  Sympathetic  and  Cerebro- Spinal  Nervous  System          .  25 

13.  Mechanism  of  the  Knee-jerk      •> •  .  •           .             .  .     27 

14.  Showing  Spinal  Segments  for  Motion  and  Sensibility  31 

15.  Segmental  Skin  Fields               «,,,.       .,.,:        •;.,.       (•;•'•'  35 

16.  Normal  Vertebral  Curves  .         :•,  4  •      ?»-..-'       ;'-•»,-'  •     4° 

17.  Spondylograms              .             .         ;  .,..          .  ..,        v-[.,r-  42 

18.  Apparatus  for  Taking  a  Spondylogram     --».          '.    :  -     43 

19.  Vertebral  Areas  of  Muscular  Spasm     .          • .  .         ij>»Ji'  49 

20.  Plan  of  the  Cervical  Plexus             .          }>-•:.•      '.-•.••  •     51 

21.  Diagrams  of  Transferred  Pains             ...  56 

22.  Illustrating  Cutaneous  Tenderness               .             .  58 

23.  Sensory  Areas  of  the  Skin  (Anterior  View)       .         -).•;. i  61 

24.  Sensory  Areas  of  the  Skin  (Posterior  View)          ,  ,./.  .     61 

25.  Sensory  Areas  of  the  Skin        ....  63 

26.  Sensory  Areas  of  the  Skin               .             .             .  -63 

27.  Painful  Head-Areas  Related  to  Visceral  Disease            .  65 

28.  Hyperalgesic  Zones             .             .             .             .  .     67 

29.  Hyperalgesic  Zones       .  .  .  .  .68 

30.  Areas  of  Vertebral  Tenderness       .             .             .  -     75 

31.  Areas  of  Vertebral  Tenderness              ...  78 

32.  The  Vibrosuppressor          .             .             .             .  .81 

33.  Effects  of  a  Dilated  Stomach  on  the  Heart       .             .  85 

34.  Area  of  Lung-Dullness  in  Dislocation  of  the  Heart  .     86 

35.  Sites  of  Indurations     .....  90 

XXI 


Illustrations 

Figure.  Page 

36.  Electric  Massage-Apparatus            .             .             .  .   101 

37.  Curves  in  Kyphosis  and  Lordosis         .             .             .  116 

38.  Relation  of  the  Spinal  Cord           .             .            .  .119 

39.  Spinal  veins     .  .  .  .  .  .127 

40.  Areas  for  Counter-Irritation           .             .            .  .148 

41.  Areas  for  Counter-Irritation     ....  149 

42.  A  Sine  Curve         .    .         .             .             .             .  .   152 

43.  The  Author's  Sinusoidal  Apparatus      .  .  .153 

44.  Kellogg's  Sinusoidal  Apparatus      .            .            .  .   154 

45.  The  Victor  Sinusoidal  Apparatus          .  .  .155 

46.  Interrupting  Electrodes      .             .             .             .  .   156 

47.  Electro-Motor  Points  of  the  Muscles  of  the  Back         .  157 

48.  Vertebral  Areas  for  Eliciting  Visceral  Reflexes        .  .   1 70 

49.  Cutaneous  Areas  for  Influencing  the  Viscera    .             .  174 

50.  Pneumatic  Hammer           .             .            .             .  .   177 

51.  Electric  Concussion-Hammer  .             .                          .  179 

52.  Diagram  of  a  Thoracic  Nerve        .             .             .  .   183 

53.  Cutaneous  Nerves  of  the  Thorax  and  Abdomen            .  184 

54.  Illustrating  the  Heart  Reflex  ....   200 

55.  Illustrating  the  Heart  Reflex    ....  201 

56.  Sphygmogram  After  Inhaling  Ammonia     .             .  .   202 

57.  Illustrating  the  Heart  Reflex    ....  206 

58.  Illustrating  the  Heart  Reflex           .             .             .  .206 

59.  Sphygmogram  After  Straining  at  Stool              .             .  208 

60.  Illustrating  the  Heart  Reflex  in  Myocarditis            .  .220 

61.  Illustrating  the  Heart  Reflex  in  Myocarditis     .             .  220 

62.  Illustrating  the  Heart  Reflex  After  Using  Digitalis  .   225 

63.  Position  of  Leg  for  Palpating  the  Tibial  Artery            .  226 

64.  Demonstrating  the  Amplitude  of  the  Heart  Reflex  .   227 

65.  Position  of  Head  to  Inhibit  the  Heart         .             .  .228 

66.  Sphygmomanometer     .....  245 

67.  Rubber-Ring  for  Excluding  Auto-Pulsations           .  .   246 

68.  Relation  of  Heart  and  Aorta  to  the  Chest- Wall             .  254 

69.  Aortic  Reflex  of  Contraction  in  Aneurysm               .  .   255 

70.  Aortic  Reflexes  in  Aneurysm  (Posterior  View)               .  255 

71.  Aortic  Reflexes      ......  260 

72.  Aortic  Reflexes  of  the  Abdominal  Aorta           .            .  263 


XXII 


I     I     I     u 


a     t     i      o      n 


Figure  page 

73.  Reflex  of  the  Abdominal  Aorta           ....  265 

74.  Path  of  a  Vasoconstrictor  Nerve  .  .  .  .273 

75.  Photograph  of  Exophthalmic  Goitre  .                       .           .  282 

76.  Photograph  of  Exophthalmic  Goitre        .           .           .  283 

77.  Types  of  Breathing       ......  289 

78.  Diagram  of  the  Respiratory  Center          .           .           .  290 

79.  Atelectatic  Zones  .  .  .  .  .  .300 

80.  Atelectatic  Zones      .           .           .  -         .           .           .  300 

81.  Illustrating  the  Bronchial  Tubes  in  Asthma             .           .  308 

82.  Arrangement  of  Bottles  for  Promoting  Lung-Contraction  314 

83.  Nerves  of  the  Stomach          '   .           .           .           .           -  317 

84.  Illustrating  Traube's  Space           .           .           .           .  318 

85.  Effects  of  Ether-Inhalation  on  the  Stomach  .           .           .  319 

86.  Percussion  of  Stomach  by  the  Vago- Visceral  Reflex      .  322 

87.  Liver  Reflex  of  Contraction     .....  332 

88.  Liver  Reflex  of  Dilatation  .           .          ".'          .           .  333 

89.  Cardio-Splanchnic  Phenomenon         T           .           .           .  346 

90.  Splenic  Reflexes       .           .                   •'.-.           .           .  353 

91.  Kidney  Reflexes             .           .          ;i           .           .           .  360 

92.  Skin-Areas  Related  to  Spinal  Segments  .           .           .  368 

93.  Skin- Areas  Related  to  Spinal-Segments         .           .           .  368 

94.  Peripheral  Distribution  of  Sensory  Nerves         .           .  372 

95.  Peripheral  Distribution  of  Sensory  Nerves    .           .           .  373 

96.  Location  of  the  Gasserian  Ganglion        .           .           .  374 

97.  Localization  of  the  Motor  Area          ....  384 

98.  Concussor     .......  396 

99.  Mclntosh  Polysine  Generator             ....  398 

100.  Double  Vacuum  Electrode  .  .  .  .399 

101.  Illustrating  Origin  and  Distribution  of  Autonomic  Fibers  412 

102.  Course  of  Autonomic  Fibers         ....  426 

103.  Patches  of  Dullness  of  the  Splanchnic  Vessels          .           .  433 

104.  Dullness  in  Insufficiency  of  the  Splanchnic  Vessels       .  433 

105.  Diagram  of  Pilo-Motor  Reflexes         ....  436 

106.  Illustrating  Mechanism  of  Reflexes          .           .           .    .  438 

107.  Diagram  of  a  Spinal  Nerve      .....  440 

108.  The  Ocular  Nervous  System         ....  442 

109.  Diagram  of  the  Vagus  Nerves            ....  447 


XXIII 


I     I     I     u 


a      t     i      o      71 


Figure  Page 

1 10.  Illustrating  the  Effects  of  Pilocarpin  on  an  Aneurysm           458 

in.  Illustrating  the  Action  of  Adrenalin  on  an  Aneurysm         .  459 

112.  Radicularpressor      ......         468 

113.  Cardiac  Nerves  in  the  Rabbit  ....  469 

114.  Base-Knob    .......         476 

115.  Heart  Reflex  by  Extension  of  Cervical  Muscles       .  -  477 

116.  Apparatus  for  Paravertebral  Pressure      .  .           .         478 

117.  Tracings  in  Exophthalmic  Goitre       ....  493 

118.  Illustrating  Threshold  Percussion  .           .           .         511 

119.  Cardiac  Nerves  .......   519 

120.  Illustrating  the  Rose  Bandage       .  .           .           .531 

121.  Method  for  Supporting  the  Abdomen  .           .           .   532 

122.  Contents  of  the  Mediastina  .           .           .           .554 

123.  Boundaries  of  Heart  and  Great  Vessels         .  .           -   557 

124.  Percussion-Zones  of  the  Spine       ....         559 

125.  Postural  Method  of  Percussing  the  Aorta      .  .   560 

126.  Fluoroscopy  of  the  Aorta    .....         561 

127.  Radioscopy  of  the  Aorta  .....   563 

128.  Percussion-Areas  of  an  Aneurysm  .           .           .         565 

129.  Apparatus  for  Taking  Tracings  of  the  Aorta  .           .   566 

130.  Aortograms  .......         567 

131.  Aneurysm  of  the  Thoracic  Aorta        ....   571 

132.  Intrathoracic  Shadow  (Misinterpreted)    .  .           .         576 

133.  Primitive  Apparatus  for  Concussion  ....   582 

134.  Radioscopy  of  the  Stomach  ....         584 

135.  Diagrammatic  Outline  of  the  Stomach          .  .           .   585 

136.  Percussion  of  the  Stomach  (Vago- Visceral  Method)      .         587 

137.  Intestinal  Areas  of  Dullness  by  Paravertebral  Pressure       .   593 

138.  Topography  of  the  Alimentary  Canal      .  .           .         594 

139.  Gall-Bladder  (Method  of  Locating)    ....   598 

140.  Vascular  Supply  of  an  Alveolus    ....         602 

141.  Vascular  Parallelogram  and  Triangles  of  Grocco    .  .  607 

142.  Arrangement  of  the  Pulmonary  Blood-Vessels    .  .         609 

143.  Mask  of  Kuhn   .......  610 

144.  Reclining  Chair  of  Jacoby  .           .           .           .         611 

145.  Tracheo-Bronchial  and  Broncho-Pulmonary  Glands          .   622 

146.  Posterior  View  of  the  Opened  Head,  Neck  and  Trunk  631 
SPONDYLOTHERAPEUTIC  Armamentarium     .           .           .  648 

XXIV 


SPONDYLOTHERAPY 


CHAPTER  I. 

HISTORICAL. 

PRIMITIVE  ERA  OF  SPONDYLOTHERAPEUTICS — THE  GRIFFIN  BROTHERS 
—SWEDISH  GYMNASTS  — OSTEOPATHY — CHIROPRACTIC — DANA  — 
QUINCKE — HEAD — THE  VERTEBRAL  REFLEXES. 

TN  the  primitive  era  of  hydrotherapy,  the  application  to 
the  spinal  region  of  the  hot-water  bag  and  ice-bag  was 
a  conventional  procedure  dictated  by  empiricism  with  little 
physiologic  knowledge  concerning  the  action  of  water  on 
the  spinal  centers.  Even  at  the  present  day,  our  thera- 
peutic armament  embraces  various  physical  methods  which 
are  indiscriminately  employed  with  neither  rhyme  nor  reason. 
Thus  therapeutics  is  discredited  and  any  good  results  achieved 
from  treatment  are  attributed  to  suggestion.  We  dare  not 
wholly  ignore  the  physical  methods  of  treatment  even  though 
there  is  no  physiologic  reason  to  justify  their  employment, 
although  it  should  be  the  constant  effort  of  the  physician  to 
rationalize  his  methods.  We  are  not  justified  in  discrediting 
clinical  observations  because  they  have  not  been  confirmed 
in  the  laboratories.  Gowers  observes,  "The  diseases  of 
which  we  know  the  least  pathology  are  the  diseases  which 
we  treat  successfully." 

We  should  be  prepared  to  welcome  new  truths,  even, 
though,  as  Gcethe  observed,  they  threaten  to  overturn 
beliefs  which  we  have  entertained  for  years  and  have  handed 
down  to  others. 

One  must  not  forget,  however,  the  unconscious  tendency 
of  specialists  to  exaggerate  the  importance  of  some  special 
method  of  treatment. 


Spondylotherapy 

In  the  presence  of  abdominal  pain,  the  surgeon  who  uses 
his  head  as  well  as  his  knife  thinks  of  appendicitis,  but  when 
he  uses  his  knife  to  the  exclusion  of  his  head,  he  thinks  of 
nothing  else.  There  is  the  gynecologist  whose  conception 
of  disease  is  limited  to  the  uterus  and  adnexa,  and  there  is 
the  oculist  with  mental  astigmatism,  who  reflects  his  sub- 
jectivity in  the  examination  of  his  patients. 

We  all  know  the  tendency  to  patronize  special  organs, 
diseases  or  remedies,  and  the  poet  Crabbe,  in  verse,  thus 
immortalizes  this  tendency: 

"One  to  the  gout  contracts  all  human  pain, 
He  views  it  raging  in  the  frantic  brain; 
Finds  it  in  fevers,  all  his  efforts  mar, 
And  sees  it  lurking  in  the  cold  catarrh. 
Bilious  by  some,  by  others  nervous  seen, 
Rage  the  fantastic  demons  of  the  spleen; 
And  every  symptom  of  the  strange  disease, 
With  every  system  of  the  sage  agrees." 

THE  GRIFFIN  BROTHERS. 

In  1834  William  and  Daniel  Griffin,  physicians,  respect- 
ively, of  Edinburgh  and  London,  published  a  work  in  which 
148  cases  were  analyzed  showing  the  relation  of  certain 
symptoms  to  definite  spinal  regions.  These  symptoms  were 
associated  with  spinal  tenderness  in  fixed  regions.  They 
concluded  that  the  tenderness  in  question  was  either  primary 
in  the  spinal  cord  or  secondary  to  visceral  or  other  diseases. 
The  Griffin  Brothers  queried  as  follows:  "We  should  like 
to  learn  why  pressure  on  a  particular  vertebra  increases,  or 
excites,  the  disease  about  which  we  are  consulted,  why  it 
at  one  time  excites  headache  or  croup  or  sickness  of  the 
stomach."  "Why,  in  some  instances,  any  of  these  complaints 
may  be  called  up  at  will  bv  touching  a  corresponding  point 

2 


The     G    r   i  ffi   n     Brothers 


of  the  spinal  chain?"     The  following  table  by  the  Griffin 
Brothers1  demonstrates  the  tender  areas  of  the  spine: 


CASES. 

Twenty-eight  cases  of 
cervical  tenderness, 
8  men;  8  married, 
12  unmarried. 

Forty-six  cases  of  cer- 
vical and  dorsal 
tenderness,  7,  15 
married,  24  un- 
married. 

Twenty-three  cases  of 
dorsal  tenderness, 
4,  o  -  -  6  married, 
1 6  unmarried. 


Fifteen  cases  of  dorsal 
and  lumbar;  i  man; 
ii  married,  3  un- 
married. 

Thirteen  cases  of  lum- 
bar tenderness. 


Twenty-three  cases, 
all  of  the  spine,  4,  o 
—4  married,  15  un- 
married. 

Five  cases;  no  tender- 
ness of  the  spine. 


PROMINENT    SYMPTOMS. 

Headache,  nausea  or  vomiting, 
face-ache,  fits  of  insensibility,  af- 
fections of  the  upper  extremities. 
In  2  cases  only,  pain  of  stomach ; 
In  5,  nausea  and  vomiting. 

In  addition  to  the  foregoing 
symptoms,  pain  oi  stomach  and 
sides,  pyrosis,  palpitation,  op- 
pression. In  34  cases,  pain  of 
stomach.  In  10  cases,  nausea 
or  vomiting. 

Pain  in  stomach  and  sides, 
cough,  oppression,  fits  of  syn- 
cope, hiccough,  eructations.  In. 
one  case  only,  nausea  and  vomit- 
ing. In  almost  all,  pain  of 
stomach. 

Pain  in  abdomen,  loins,  hips, 
lower  extremities,  dysury,  isch- 
ury  in  addition  to  the  symptoms 
attendant  on  tenderness  of  the 
dorsal.  In  i  case  only,  nausea. 

Pains  in  lower  part  of  abdo- 
men, dysury,  ischury,  pains  in 
testes  or  lower  extremities,  or 
disposition  to  paralysis.  In  i 
case  only,  spasms  of  stomach  and 
retching. 

Combines  the  symptoms  of  all 
the  foregoing  cases. 


Cases  resembling  the  foregoing. 
3 


Spondylotherapy 

At  this  period  (1834)  Swedish  gymnasts,  notably  Ling, 
observed  among  cardiopaths,  tenderness  over  the  4th  or  5th 
dorsal  nerves  when  this  region  was  subjected  to  friction. 
The  Swedish  school  recognizes  definite  areas  of  spinal  ten- 
derness identified  with  the  various  organs.  Thus,  in  affec- 
tions of  the  stomach,  tenderness  is  observed  in  the  region  of 
the  6th,  yth  and  8th  dorsal  nerves  on  the  left  side,  and  man- 
ipulation of  the  region  in  question  often  evokes  eructations 
of  gas. 

In  1841  Marshall  Hall  published  his  memorable  work 
which  established  the  importance  of  the  spinal  reflex. 

OSTEOPATHY. 

In  1874  osteopathy  was  founded.  It  was  based  on 
the  theory  that  health  signifies  a  natural  flow  of  blood  and 
that  the  bones  may  be  employed  as  levers  to  relieve  pressure 
on  nerves,  veins  and  arteries.  The  pressure  is  assumed  to 
be  caused  by  dislocated  bones,  and,  when  the  osteopath 
refers  to  a  "lesion,"  he  intimates  malposition  of  a  bone. 

The  theory  of  the  osteopath  may  be  at  variance  with 
our  accepted  views  of  etiology,  yet  the  latter,  by  his  manipu- 
lations, unconsciously  evokes  reflexes  which  are  cogent 
factors  in  favorably  influencing  disease. 

The  osteopath  indignantly  resents  any  comparison  of  his 
system  to  massage.  The  following  statement  occurs  in  a 
representative  work  on  this  system  by  G.  D.  Hulett2: 
"Masseurs  are  aware  of  the  fact  and  the  possible  significance 
of  tender  points  in  the  tissues  along  the  spine  over  the  area 
from  which  the  nerves  are  given  off  to  the  organs  which  are 
in  a  diseased  condition;  evidently,  however,  they  have  con- 
sidered these  tender  points  as  always  secondary  to  the  dis- 
eased viscus."  "The  essential  distinction  between  osteop- 
athy and  all  other  systems  of  healing,"  continues  the  same 

4 


Chiropractic 

writer,  "based  on  manipulation,  clusters  around  the  etiology 
of  disease."  In  other  words,  in  disease  of  an  organ,  the 
masseur  acts  directly  upon  the  organ;  but  the  osteopath 
taking  into  consideration  what  he  regards  as  a  fact  "The 
ability  of  nature  to  functionate  properly,  treats  the  central 
force." 

According  to  the  foregoing,  the  osteopath  regards  disease 
from  a  central  and  not  from  a  peripheral  standpoint. 

CHIROPRACTIC. 

This  system  was  founded  in  1885.  The  theory  sustaining 
this  system  presumes  that,  in  consequence  of  displaced 
vertebrae,  the  intervertebral  foramina  are  occluded  through 
which  the  spinal  nerves  pass  (Fig.  i). 

In  this  way  the  nerves  are  pinched  and  chiropractors 
assume  that  such  pinching  is  responsible  for  95  per  cent  of 
all  diseases.  Chiropractic  concerns  itself  with  an  "adjust- 
ment" of  the  subluxations,  thus  removing  pressure  on  the 
nerves. 

What  the  chiropractor  calls  "nerve-tracing,"  consists  of 
following  a  sensitive  nerve  from  its  vertebral  exit  to  and  from 
the  affected  organs.  The  chiropractor  differentiates,  his 
method  from  osteopathy  by  the  following  asseverations : 

1.  The  hands  are  used  in  a  different  manner  and  the 

movements  are  dissimilar; 

2.  The  etiology  of  disease  is  unlike  that  accepted  by 
osteopathy; 

3.  Chiropractors  "adjust"  for  more  diseases  than  osteo- 
paths and  the  results  are  immediate. 

It  is  known  that  pain  may  be  felt  at  a  point  distant  from 
the  actual  site  of  a  lesion.  Such  pains  are  know  as  TRANS- 
FERRED PAINS.  Thus  the  pains  sometimes  felt  in  the 

5 


Spondyloth 


a   p    y 


FIG.  i. — Illustrating  the  chiropractor's  conception  of  disease.  A,  the  vertebrae 
are  in  the  normal  position  with  the  spinal  window  open  (SWO);  B,  showing  that 
with  an  open  spinal  window  the  nerve  is  not  compressed.  The  dotted  lines  show 
the  correct  alignment  of  the  spinous  processes;  C,  the  spinal  window  is  closed 
(SWC)  owing  to  displaced  vertebrae  and  in  consequence  the  nerve  at  its  exit  is 
pinched  (D).  (After  Palmer.) 


The      Vertebral     Reflexes 

mammary  gland  in  uterine  disease  and  in  the  knee  in  hip- 
joint  disease  are  transferred  or  referred  pains. 

The  well-known  illustrations  of  Dana  (page  56)  represent 
the  location  of  transferred  pains. 

In  1890  Quincke  studied  the  sites  of  SYMPATHETIC 
SENSATIONS  (page  57). 

Still  later,  in  1893,  Henry  Head,  of  London,  demonstrated 
that  in  visceral  disease,  pain  and  disturbed  sensation  may 
be  referred  to  definite  cutaneous  areas  (vide  page  58). 

THE  VERTEBRAL  REFLEXES. 

In  medical  literature  the  author  has  referred  repeatedly 
to  certain  VISCERAL  REFLEXES  elicited  by  cutaneous  irritation, 
viz.,  the  lung  reflexes  of  dilatation3  and  contraction4,  the 
heart  reflex5,  liver  reflex6,  stomach  and  intestinal  reflexes7, 
and  the  aortic  reflexes3. 

The  reflexes  in  question  are  endowed  with  more  than 
mere  physiologic  interest.  They  yield  unequivocal  demon- 
stration of  the  fact  that  the  sensory  peripheral  nerve  ter- 
minations receive  impressions  which  are  conducted,  com- 
municated or  reflected  by  aid  of  the  nervous  system. 

Such  impressions  react  on  the  viscera  and  the  manifesta- 
tions of  the  reaction  may  be  utilized  in  a  diagnostic  and 
therapeutic  direction. 

The  evidence  heretofore  adduced  in  explanation  of  the 
results  achieved  by  electric,  hydriatic,  mechanic  and  bal- 
neary treatment  of  disease  was  naught  else  than  a  mere 
array  of  words  conceived  only  in  conjecture. 

The  cutaneous  visceral  reflexes  referred  to,  suggest  the 
rationale  of  the  different  peripheral  methods  of  treatment. 

Visceral  reflexes  may  be  evoked  not  only  by  cutaneous 
irritation  but  likewise  by  concussion  and  the  application  of 

7 


Spondylotherapy 

the  sinusoidal  current  to  the  spinous  processes  of  the  verte- 
brae. 

Reflexes  elicited  from  the  spinous  processes  have  been 
specified  by  the  author  as  VERTEBRAL  REFLEXES.  9 

The  manipulation  of  definite  vertebrae  corresponds  with 
the  elicitation  of  specific  reflexes,  but,  if  the  spinous  processes 
are  promiscuously  manipulated,  counter-reflexes  are  evoked 
which  nullify  the  reflexes  sought.  As  we  proceed  with  our 
subject,  we  will  determine  that  vertebral  manipulation  is 
influential  for  weal  or  woe  in  the  treatment  of  disease  and 
it  will  be  the  endeavor  of  the  author,  to  endow  spondylothera- 
peutics  with  some  scientific  accuracy  and  thus  substitute 
order  for  chaos. 

To  excite  the  vertebral  reflexes  for  therapeutic  purposes, 
concussion  by  means  of  an  apparatus  (page  176)  or  the 
sinusoidal  current  (page  151)  is  employed.  For  diagnostic 
purposes,  either  the  sinusoidal  current  or  simple  concussion 
after  the  manner  to  be  described  is  used.  When  the  current 
is  employed,  the  moistened,  indifferent  pad  (usually  large) 
is  placed  over  the  sacral  region,  whereas  an  interrupting 
electrode  (Fig.  46),  which  permits  one  to  close  and  open  the 
circuit,  is  placed  over  definite  spinal  processes. 

For  simple  concussion  the  author  employs  a  piece  of  soft 
rubber  or  linoleum  about  6  inches  long,  i^  inches  wide,  and 
about  a  \  of  an  inch  in  thickness  as  a  pleximeter  for  receiving 
the  stroke  and  a  plexor  with  a  large  piece  of  thick  rubber 
for  delivering  the  blow  (Fig.  2). 

The  plexor  used  by  the  author  is  similar  to  that  employed 
by  French  clinicians  for  obtaining  the  knee-jerk  and  is 
known  as  the  plexor  of  Dejerine. 

In  the  absence  of  the  latter,  a  mallet  or  even  an  ordinary 
tack-hammer  will  suffice. 

One  may  also  strike  the  spinous  processes  with  the 

8 


The    Vertebral  Reflexes 


FlG.  2. — Plexor  and  pleximeter  employed  for  eliciting  the  vertebral  reflexes. 

knuckles  or  better  still,  the  ringers  may  be  used  as  a  plexi- 
meter and  the  clenched  fist  as  a  plexor.  In  the  latter  instance, 
the  palmar  surfaces  of  the  fingers  are  applied  to  the  spinous 
processes  to  be  concussed,  and,  with  the  clenched  fist,  the 
dorsal  surfaces  of  the  fingers  are  struck  a  series  of  short  and 
vigorous  blows  (Fig.  3) . 

The  use  of  a  pleximeter  and  plexor  is  decidedly  more 
effective  than  the  latter  method  which  is  only  employed  in 
an  emergency.  Here  the  strip  of  linoleum  or  rubber  is 
applied  to  the  spinous  process  or  processes  to  be  concussed, 
and,  with  the  hammer,  a  series  of  sharp  and  vigorous  blows 
are  allowed  to  fall  upon  the  pleximeter. 


S  p    o     ndylotherapy 


FIG.  3. — Showing  the  method  of  concussing  the  spinous  processes  with  the 
hands  for  eliciting  the  vertebral  reflexes. 

Naturally,  the  blows  jar  the  patient  somewhat,  but  be- 
yond this  no  inconvenience  is  suffered. 

The  vertebral  reflexes,  when  the  stimulant  is  concussion, 
are  probably  due  to  transmitted  mechanic  stimulation  of  the 
roots  of  the  spinal  nerves,  insomuch  as  many  physiologists 
contend  that  the  spinal  cord  does  not  react  to  direct  stimuli. 
In  some  instances  concussion  is  more  effective  than  the 
sinusoidal  current  in  eliciting  certain  vertebral  reflexes, 
whereas,  in  other  instances,  the  current  supersedes  concus- 
sion. The  relative  value  of  these  methods,  however,  will  be 
studied  in  detail  in  succeeding  chapters.  There  is  yet  an- 
other method  for  eliciting  the  vertebral  reflexes  by  means  of 

10 


The    Vertebral    Reflexes 

pressure  at  the  vertebral  exits  of  definite  spinal  nerves 
(page  169). 

Reference  to  Fig.  4  shows  the  spinal  muscular  reflexes 
thus  far  elicited  by  the  author,  whereas,  Fig.  5  represents  the 
viscero-motor  reflexes  of  spinal  origin.  The  latter,  with  the 
exception  of  the  aortic  reflexes,  probably  act  on  the  muscu- 
lature of  the  organs  independently  of  the  vaso-motor  system. 

Unstriped  or  involuntary  muscular  fibers  are  present  in 
practically  all  the  organs  of  the  body.  Even  the  liver  is  not 
exempt.  Here  the  muscular  fibers  contained  in  the  fibrous 
coat  of  the  organ  enter  the  organ  at  the  transverse  fissure. 

The  viscera,  even  in  health,  vary  in  size,  and  this  alter- 
nate enlargement  and  diminution  in  bulk  is  due  in  part  to 
variations  in  the  supply  of  blood  and  in  part  to  the  contract- 
ility of  the  visceral  musculature. 

If  I  am  permitted  to  digress  for  a  moment  to  give  expres- 
sion to  my  prejudiced  conception  of  many  morbid  manifesta- 
tions, I  witness  muscular  tissue  in  a  state  of  incoordination  j 
uncontrolled  by  will  and  subordinated  to  the  vagaries  of  un- 
disciplined reflex  centers,  the  muscular  orgy  presents  the 
tableau  of  muscles  gone  mad.  Practically  everywhere 
throughout  the  organism  where  muscle  is  found,  fibers  co- 
exist which  dilate  or  contract.  When  neither  function  pre- 
dominates there  are  no  morbid  manifestations;  in  other 
words,  a  normal  function  is  a  question  of  muscular  equilib- 
rium. The  moment  one  set  of  fibers  gains  the  ascendancy 
over  its  antagonist  the  symptomatic  picture  is  made  up  of 
spasm  or  paralysis  (vide  Asthma,  page  303). 

SPINAL  MUSCULAR  REFLEXES. 

These  reflexes  are  best  elicited  by  means  of  a  powerful 
sinusoidal  current  after  the  manner  already  described  (page 
u).  Concussion  by  means  of  the  plexor  and  pleximeter 

11 


S  p    ondyloth     e     r    a    p    y 

will  also  excite  some  of  them.  It  will  be  observed  that  the 
reflexes  in  question  are  bilateral,  in  contradistinction  to  the 
conventional  cutaneo -peripheral  reflexes,  which  are  unilateral. 

For  the  convenience  of  their  clinical  elicitation  they  have 
been  studied  with  relation  to  definite  vertebral  spinous 
processes. 

It  must  be  observed,  however,  that  the  areas  in  question 
may  vary  in  different  patients,  but,  as  here  cited,  the  areas 
are  approximately  correct.  Like  all  reflexes,  the  degree  of 
stimulation  necessary  for  their  excitation  varies  with  the  indi- 
vidual, but,  as  a  rule,  powerful  currents  are  necessary.  Practi- 
cally every  muscle,  or  group  of  muscles,  may  be  brought  to 
contraction,  but,  insomuch  as  this  work  is  designed  for  a 
utilitarian  rather  than  an  academic  purpose,  only  a  few  mus- 
cular reflexes  thus  far  elicited  by  the  author  will  be  cited. 

1.  STERNO-CLEIDO-MASTOID  REFLEX. — This  is  best  ob- 
served when  the  head  is  flexed  and  when  the  interrupting 
electrode  is  fixed  over  the  spinous  process  of  the  yth  cervical 
vertebra.     Concussion  of  the    latter  will   also   evoke    the 
reflex.     This   bilateral  reflex  is   most  pronounced   at  the 
sterno -clavicular  attachment  of  the  muscles. 

2.  BICEPS,    TRICEPS,   AND    WRIST-JERK. — Elicited   by 
concussion  of  the  spinous  processes  of  the  5th  and  6th  cervical 
vertebrae  or  by  application  of  the  current  to  the  same  proc- 
esses.    Here  the  processes  are  concussed  in  succession  or 
the  electrode  used  is  large  enough  to  embrace  both  spinous 
processes.     The  upper  extremities  must  be  placed  in  a  state 
of  flexion,  with  muscles  absolutely  relaxed  and  the  elbows 
resting  in  either  hand  of  an  assistant.     The  elbows  may  also 
rest  on  a  table  in  the  flexed  position  and  relaxed. 

3.  PALMAR  REFLEX. — This  consists  of  a  contraction  of 
two  or  more  fingers  when  the  interrupting  electrode  is  ap- 
plied over  the  spinous  process  of  the  6th  cervical  vertebra. 

12 


T  h 


Vertebral      Reflexes 


4.  PECTORAL  REFLEX. — The  patient  lies  on  his   side 
with  arms  elevated  to  bring  the  pectoral  muscles  into  slight 
prominence,  after  which  the  dorsal  spinous  processes  (3d  to 
the  6th)  are  either  concussed  or  sinusoidalized. 

5.  SCAPULAR  REFLEX. — Concussion  or  sinusoidalization 
of  the  5th  cervical  spinous  process. 


****& 

FIG.  4. — The  spinal  muscular  reflexes. 

6.  EPIGASTRIC  REFLEX. — Concussion  or  sinusoidaliza- 
tion of  the  dorsal  spinous  processes  (yth  to  the  Qth). 

7.  GLUTEAL  REFLEX. — When  the  patient  is  on  his  side 
sinusoidalization  or  concussion  of  any  of  the  lumbar  verte- 
brae.   The  reflex  is  accentuated  as  the  last  lumbar  vertebra 
is  attained. 

8.  CREMASTERIC  REFLEX. — When  the  ist,  2nd  and  3d 
lumbar  vertebrae  are  concussed  or  sinusoidalized. 

13 


WES.  BARRETT 


S   p 


o     n 


d    y    I 


t    h 


r    a    p    y 


9.  SPHINCTER  ANI  REFLEX. — Sinusoidalization  with  a 
small  electrode  at  a  point  corresponding  to  the  sacro-coccy- 
geal  articulation. 

10.  ADDUCTOR  REFLEX. — Adduction  of  both  lower  ex- 
tremities when  the  spinous  processes  of  all  the  lumbar  verte- 
brae are  sinusoidalized  or  concussed.     The  patient  sits  on 
a  chair,  with  both  lower  extremities  extended  and  relaxed. 


£Br^fS?»s 


FIG.  5. — Viscero-motor  reflexes  of  spinal  origin.     . 

ii.  QUADRICEPS  REFLEX. — With  the  patient  seated  and 
legs  extended,  concussion  or  sinusoidalization  of  the  spinous 
process  of  the  2nd  lumbar  vertebra  will  produce  a  decided 
contraction  of  the  quadriceps  femoris.  It  may  be  noted  that 
it  is  a  contraction  of  this  muscle  which  is  responsible  for  the 
patellar  reflex  (knee-jerk).  When  one  leg  is  crossed  upon 
the  other  (the  conventional  position  for  eliciting  the  knee- 
jerk),  a  knee-jerk  can  be  obtained  in  the  norm.  In 

14 


The    Vertebral    Reflexes 

several  tabetics  in  whom  the  knee-jerk  was  absent  (by 
tapping  the  patellar  tendon)  it  was  very  much  exaggerated 
in  either  one  or  the  other  leg  when  one  leg  was  crossed  upon 
the  other  during  sinusoidalization  (with  the  interrupting 
electrode)  of  the  spinous  process  of  the  2nd  lumbar  vertebra. 
The  foregoing  phenomenon  is  discussed  on  page  28. 

12.  ACHILLES  REFLEX. — The  patient  rests  on  his  knees 
on  a  chair,  with  feet  projecting  over  the  edge  of  the  latter. 
In  the  conventional  way,  striking  the  Achilles  tendon  results 
in  flexion  of  the  foot. 

With  the  patient  in  the  same  position  the  interrupting 
electrode  is  fixed  over  the  sacrococcygeal  articulation,  where- 
as the  large  pad  is  applied  in  the  lumbar  region.  Here,  like- 
wise, the  current  evokes  flexion  of  the  foot. 

13.  PLANTAR  REFLEX. — Evoked  by  sinusoidalization  of 
the  ist  and  2nd  sacral  segments. 

14.  BABINSKI  REFLEX. — If,  in  the  norm,  we  irritate  the 
inner  side  of  the  sole  of  the  foot  from  the  heel  to  the  toes  by 
stroking  with  a  moderately  sharp  object,  all  the  toes  undergo 
plantar  flexion ;  but,  if  the  great  toe  (and  perhaps  the  other 
toes)  undergoes  dorsal  flexion  (Fig.  6),  the  Babinski  reflex 
or  phenomenon  is  present.     As  a  rule  the  latter  phenomenon 
indicates  a  lesion  of  the  pyramidal  tract. 

The  observations  of  the  author  show  that  the  Babinski 
reflex  may  be  elicited  in  the  norm  by  applying  the  interrupting 
electrode  (large  electrode  over  the  sacrum)  over  the  spinous 
process  of  either  the  3d  or  4th  lumbar  vertebra. 

Schneider's  explanation  of  the  Babinski  reflex  is  as 
follows ;  Plantar  flexion  of  the  toes  (the  normal  reflex)  de- 
pends upon  a  cortical  component  of  the  reflex,  whereas  dorsal 
flexion  of  the  toes  (Babinski  reflex)  depends  on  the  spinal 
component.  If  then,  there  is  a  lesion  of  the  pyramidal 
tract,  the  reflex  for  the  plantar  flexion  is  interrupted,  whereas 

15 


S   p    o     n    d    y     I    o     t    h     e     r    a    p    y 

the  spinal  component  for  dorsal  flexion  is  retained.  In 
several  cases  with  lesions  of  the  pyramidal  tract  observed  by 
the  author,  and  in  all  of  whom  the  Babinski  reflex  was  present 
by  irritating  the  sole  of  the  foot,  the  same  reflex  could  not  be 
elicited  as  in  the  norm  by  sinusoidalization  of  the  spinal 
column.  In  these  cases,  however,  the  plantar  reflex  was 
elicited  by  sinusoidalization  in  lieu  of  the  Babinski  reflex, 


FIG.  6. — The  Babinski  toe-reflex  (Hutchison  and  Rainy). 

which  occurs  in  the  normal  subject.  The  latter  observation 
would  seem  to  show  in  part  the  correctness  of  Schneider's 
explanation  of  the  Babinski  reflex.  The  occurrence  of  the 
plantar  reflex  in  these  cases  suggests  that  it  is  likewise  a 
spinal  and  not  a  cortical  reflex  and  that  its  occurrence  in 
lieu  of  the  Babinski  by  sinusoidalization  is  equally  diagnostic 
of  a  lesion  of  the  pyramidal  tract. 

The  physician  will  observe  that  the  spinal  muscular 
reflexes  (provided  the  current  remains  in  action  for  several 
seconds)  consist  of  clonic  rather  than  tonic  contractions,  and, 
furthermore,  that  the  spinal  reflexes  may  be  elicited  even 
though  the  ordinary  cutaneo -peripheral  reflexes  are  absent. 


Anatomic,  Topographic  and  Physiologic  Data 
CHAPTER  II. 

ANATOMIC,  TOPOGRAPHIC  AND  PHYSIOLOGIC  DATA. 

STRUCTURE  OF  THE  SPINAL  CORD — ROOTS  AND  DISTRIBUTION  OF  THE 
SPINAL  NERVES — LOCATION  OF  THE  SPINAL  NERVES — ANATOMIC 
LANDMARKS — SYMPATHETIC  SYSTEM — PHYSIOLOGY  OF  THE  SPINAL 
CORD — LOCALIZATION  OF  THE  FUNCTIONS  IN  DIFFERENT  SEGMENTS 
OF  THE  SPINAL  CORD. 

A  transverse  section  of  the  spinal  cord  (Fig.  7)  shows  it 
to  consist  of  central  gray  matter  containing  nerve -cells  and 


.Jl 


FIG.  7. — Illustrating  the  conducting  paths  in  the  spinal  cord  at  the  level  of 
the  third  dorsal  nerve.  The  black  part  represents  the  gray  matter;  V,  anterior, 
and  HW,  posterior  root;  A,  direct,  and  G,  crossed  pyramidal  tracts;  B,  anterior, 
column  ground  bundle;  C,  Goll's  column;  D,  postero-external  column;  E  and  F, 
mixed  lateral  paths;  H,  direct  cerebellar  tracts  (Landois). 

surrounding  white  matter  made  up  of  nerve-fibers.  The 
gray  matter  is  divided  into  the  anterior  and  posterior  horns. 
The  SPINAL  NERVES  take  their  origin  from  the  spinal  cord 
and  on  either  side  make  their  exit  through  the  intervertebral 
foramina.  There  are  31  pairs  of  spinal  nerves: 

Cervical  nerves 8  pairs 

Dorsal          "     12     " 

Lumbar        "     5     " 

Sacral  "     5     " 

Coccygeal     " i  pair 

17 


S  p    o    n    d   y    loth 


a    p    y 


ROOTS  OF  THE   SPINAL  NERVES. 

The  anterior  or  ventral  roots  arise  from  the  motor  cells 
in  the  anterior  horn  of  the  gray  matter  and  are  motor  in 
function.  The  posterior  or  dorsal  roots  arise  from  the 
nerve-cells  of  the  spinal  ganglia  from  which  they  can  be 
traced  into  the  cord  and  are  sensory  in  function. 


9' 


FlG.  8. — A  spinal  nerve  with  its  anterior  and  posterior  roots  (Testut).  i,  a 
portion  of  the  spinal  cord  viewed  from  the  left  side;  2,  anterior  median  fissure;  3, 
anterior  horn;  4,  posterior  horn;  6,  formatio  reticularis;  7,  anterior  root;  8,  posterior 
root  with  81,  its  ganglion;  9,  spinal  nerve;  g1,  its  posterior  division. 

On  the  posterior  root  of  each  of  the  spinal  nerves,  a  gang- 
lion is  found  which  is  located  in  the  intervertebral  foramen 
external  to  the  point  where  the  nerve  perforates  the  dura 
mater  (Figs.  8  and  38). 

DISTRIBUTION  OF  THE  SPINAL  NERVES. 

Just  beyond  the  ganglion,  the  roots  of  the  spinal  nerves 
unite  to  form  a  trunk  which  constitutes  the  spinal  nerve. 

After  the  latter  passes  out  of  the  intervertebral  foramen, 
it  divides  into  a  posterior  division  for  the  supply  of  the  pos- 

18 


Anatomic     Land 


mar 


terior  part  of  the  body  and  an  anterior  division  which  supplies 
the  anterior  part  of  the  body.  In  each  division  there  are 
fibers  from  the  roots  of  both  nerves. 

Each  spinal  nerve  receives  a  branch  from  the  sympa- 
thetic (Fig.  9). 


FlG.  9. — Diagram  after  Bohm  and  Davidoff  to  show  the  composition  of  a 
peripheral  nerve-trunk,  i,  axon  of  ganglion-cell;  2,  spinal  ganglion;  3,  dendrite  of 
ganglion-cell;  4,  anterior  horn  of  gray  matter  of  spinal  cord;  5,  axon  of  motor 
nerve-cell;  6,  sympathetic  ganglion;  7,  axon  of  sympathetic  neuron;  8,  nerve-trunk. 

The  roots  of  the  majority  of  spinal  nerves  pass  obliquely 
downwards  and  outwards  to  their  points  of  exit  from  the 
intervertebral  foramina,  hence  the  level  of  their  emergence 
from  the  cord  does  not  correspond  to  that  of  their  exit  from 
the  intervertebral  foramina  (Fig.  10). 

ANATOMIC  LANDMARKS. 

There  is  usually  a  furrow  or  medium  groove  in  the  back, 
at  the  bottom  of  which  lie  the  spinous  processes.  In 

19 


Spondyloth 


r    a    p    y 


S.  to  rectut  laterallt 

_  _  _^.;i  to  rectut  antic.  minor 
.  _,  Aruutomotit  t"lth 

_  .Anastomosis  atth pntumogastria 

.V.  to  rectut  antle.major. 
"2.  _~.y.  to  mastoid  region. 
,_  __|.Or«>t  auricular  ». 

' 5rron«oerK  cerv<oa<  n. 

rrapezdw,  ^n».  Scap.  and  Rhomboid. 

JSupra  clavicular  n. 
'_J  jSuj)ra-acromfai  n. 

.V.  to  Itvator  ang.  (cap. 
"Z.~-H.  to  rhomboid 
.  _  _  _  SufcocapuJar  it. 
Sui/cfariculur  n.  * 


.V.  topettorolli  major. 


mflexx. 

__JfuscuI<xufaneou«  ». 
___Jtfed(ann. 
.Radial  n. 

_^_^L  _i~l'/nterno/<n«(on«>u«i». 

Internal  cutaneout  n. 


V.  (a  ophincttr  ani _  _  _  —  —  _ 
Coccy^eai  n_  _  _   _  _  _  _ 


-,  External  eufatwoK*  «. 

--Qcntto-cruraln. 


interior  eruratn. 
-  _  -  -^OMurator  n. 


Superior  gluteal  n. 


—If.  to  ptHformlt 

.  .If.  to  gcmcllus  super. 


—  -V  to  gcmflhts  infer. 
—N.  to  guadratui 


FIG.  10. — The  relations  of  the  segments  of  the  spinal  cord  and  their  nerve- 
roots  to  the  bodies  and  spines  of  the  vertebrae  (Dejerine  et  Thomas,  modified  by 
Starr). 

20 


Anatomic     Landmarks 

emaciated  individuals  the  spinous  line  replaces  the  groove. 
The  spinal  furrow  is  less  evident  in  the  cervical  than  in  the 
lumbar  region;  in  the  former  situation  it  is  between  the 
trapezii  and  between  the  larger  erector  spinae  muscles  in 
the  dorsal  and  lumbar  regions. 

Palpation  and  definition  of  the  vertebral  spinous  processes 
are  facilitated  by  directing  the  patient  to  lean  far  forward  or 
the  processes  may  be  rubbed  with  the  hand,  thus  evoking  a 
spot  of  hyperemic  redness  over  the  tip  of  each  spinous 
process. 

The  5th  lumbar  spine  (marked  by  a  depression)  is  used 
for  measuring  the  external  conjugate  diameter  of  the  pelvis. 
The  latter  diameter  from  the  depression  to  the  upper  border 
of  the  symphysis  pubis  measures  2o|  cm.  or  8|  inches.  The 
two  posterior  superior  spinous  processes  of  the  ilium  are  on 
a  line  with  the  3d  sacral  spine  below  which  lie  the  sacro-iliac 
joints. 

PETIT' s  TRIANGLE  is  a  triangular  space  corresponding 
to  the  central  point  of  the  crest  of  the  ilium  (Fig.  47). 

This  triangle  is  the  occasional  site  of  a  lumbar  hernia  and 
is  also  a  convenient  region  for  relieving  congestion  of  the 
kidney  by  local  bleeding. 

Deep  pressure  made  in  the  neck  in  the  direction  of  the 
carotid  artery  and  opposite  the  cricoid  cartilage  detects  a 
tubercle  belonging  to  the  transverse  process  of  the  6th 
cervical  vertebra  and  is  known  as  CHASSAIGNAC'S  TUBERCLE. 
Against  the  latter  the  carotid  artery  may  be  compressed  by 
the  finger. 

The  VERTEBRAL  ARTERY  may  be  compressed  in  the 
suboccipital  region,  the  thumb  and  finger  of  one  hand  being 
placed  in  the  hollows  behind  the  mastoid  process,  while 
counterpressure  is  made  by  the  other  hand  on  the  forehead. 
As  the  arteries  lie  under  the  complexus  muscle,  the  pressure 

21 


S   p 


o    n 


t    h 


r    a   p   y 


must  be  rather  firm.  If  such  pressure  inhibits  pulsating 
noises  or  vertiginous  feelings,  the  inference  is  that,  these  are 
caused  by  congestion  in  regions  supplied  by  branches  of  the 


FIG.  n. — Diagram  of  the  posterior  aspect  of  the  thorax  and  abdomen  and 
showing  the  relation  of  the  viscera  to  the  surface.  Liver  (L) ;  spleen  (S) ;  kidneys 
and  ureters  (KU). 

basilar  artery  (internal  ear).  If  noises  in  the  ear  are  dimin- 
ished by  compression  of  the  carotid  artery,  they  are  prob- 
ably caused  by  congestion  in  the  middle  or  external  ear,  and 
are  often  synchronous  with  the  pulse. 


L 


a 


n 


d 


m 


a 


SPINES  OF  THE 
VERTEBRAE. 

Atlas. 


Axis. 

4th  cervical  vertebra. 
6th  cervical  vertebra. 

7th  cervical  vertebra 
(Vertebra  prominens) 

2d  dorsal  spine. 


36  dorsal  spine. 
4th  dorsal  vertebra. 


7th  dorsal  spine, 
roth  dorsal  vertebra. 

1 2th  dorsal  spine. 
4th  lumbar  spine. 


LANDMARKS. 

RELATION. 

On  a  line  with  the  hard  palate.  The  trans- 
verse process  is  just  below  and  in  front  of 
the  tip  of  the  mastoid  process. 

Felt  beneath  the  occiput  and  is  on  a  level  with 
the  free  edge  of  the  upper  teeth. 

Opposite  the  hyoid  bone. 

On  a  line  with  the  cricoid  cartilage.  Esoph- 
agus commences. 

Easily  recognized,  owing  to  its  prominence 
and  serves  as  a  guide  for  counting  the  proc- 
esses downwards.  Location  of  the  in- 
ferior cervical  ganglion. 

Corresponds  to  the  head  of  the  3d  rib.  The 
scapula  covers  the  ribs  from  the  2nd  to  the 
yth,  inclusive.  The  apex  of  the  lower  lobe 
of  the  lung  is  at  the  lev  el  of  the  3d  rib  behind. 

Corresponds  to  the  inner  edge  of  the  spine  of 
the  scapula.  Termination  of  the  arch  of 
the  aorta  on  the  left  side. 

Opposite  the  junction  of  the  ist  and  2nd  section 
of  the  sternum.  Thoracic  aorta  commences 
to  the  left.  Trachea  bifurcates  midway 
between  the  3d  and  4th  dorsal  spines,  the 
roots  of  the  lungs  thus  lying  a  little  below 
and  external. 

Corresponds  to  the  inferior  angle  of  the  scap- 
ula when  the  patient  is  sitting  with  the 
arms  hanging  at  the  side. 

Corresponds  to  the  tip  of  the  ensiform  cartil- 
age. Lower  edge  of  lung  posteriorly.  Car- 
diac orifice  of  the  stomach. 

Corresponds  to  the  head  of  the  last  rib. 
Aortic  orifice  in  diaphragm. 

Highest  point  of  the  crest  of  the  ilium.  The 
umbilicus  is  near  the  same  plane.  Division 
of  the  aorta.  Below  the  tip  of  this  spine, 
point  of  election  for  lumbar  puncture.  The 
disk  of  this  vertebra  corresponds  to  the 
ileo-cecal  valve. 

23 


S    p     on     d    y     I    o     t    h     e     r    a   p    y 


LOCALIZATION  OF  THE   SPINAL  NERVES. 

In  the  adult,  as  a  rule,  the  spinal  cord  extends  from  the 
lower  surface  of  the  foramen  magnum  to  the  lower  edge  of 
the  ist  lumbar  vertebra,  and  only  exceptionally  as  far  as  the 
2nd  lumbar  vertebra. 

The  position  of  the  cord  shows  slight  alterations  in  posi- 
tion in  the  movements  of  the  body.  Thus  it  rises  during 
spinal  flexion.  The  root -origin  of  the  spinal  nerves  may  be 
determined  as  follows  (Consult  Fig.  10) : 

For  the  upper  4  CERVICAL  NERVES  Thus  the  root-origin  of  the  3d 

subtract  i  from  the  number  of  cervical  is  opposite  the  2nd  cer- 

the  nerve.  vical  spine. 

For  the  4  lower  cervical  nerves  and  Thus  the  root-origin  of  the  8th 

upper  6  DORSAL  NERVES,  sub-  cervical   nerve  corresponds   to 

tract  2  from  the  number  of  each  the  6th  cervical  spine. 

nerve. 

For  the  lower  6  dorsal  nerves  sub-  Thus  the  root-origin  of  the  gth 

tract  3  from  the  number  of  the  dorsal  is  opposite  the  6th  dorsal 

nerve.  spine. 

The  LUMBAR  NERVES  take  their  origin  contiguous  to  the 
loth  and  nth  dorsal  spines  and  the  SACRAL  NERVES  between 
the  nth  dorsal  and  ist  lumbar  spines. 

THE  SYMPATHETIC  SYSTEM. 

This  portion  of  the  nervous  system  is  concerned  in  the 
distribution  of  impulses  to  the  glandular  structures,  cardiac 
muscle  and  the  non-striated  muscular  tissue  of  the  body. 
While  this  system  is  not  supposed  to  be  independent  in 
action  of  the  cerebro -spinal  system,  Langley  employs  the 
term  autonomic  to  indicate  that  the  efferent  fibers  of  the 
sympathetic  are  endowed  with  a  certain  independence  of  the 
central  nervous  system.  The  autonomic  fibers  are  removed 
from  the  control  of  the  will  and  preside  over  unconscious 

24 


Internal  Carotid plezus 

ffami  communicantts 
ot tit/fen  yangliated  ford  and 
Ga/iylioa juyu/are  N.  Vagi* 

To  Ganglion  petrosum 
N.  Glosso-pharyngei 

Cervical  nerve 


Caverxotap/aal 


FlaasakoutVertebral  art.--t 
Plata  atattSidclapian  art. 


Thoracic  Herat    JT 

jr 


•^Connections  with  Vagus  £  Glosso-pAarynytal 
fojbrm  f/iarynyeal  plexus. 


fSubmajcillartf  (faxalion 

•Superior'   \ 
f  Mid  die    \ 
'     jlnjeriof) 
f 

^Connections  with  Vayus  and 
V     f'\  Recurrent  larynqeal  nent% 


"l  left  Pulmonary  plucus 
CARDIAC  PLEXUS 


^InfenorMesenteric  plans 


\  I  Auerbach 

flenuesof  J      an^ 

(  Meissner 


ff 
V 

Coctyyeal  neroe 


ic  plexus 


mpocAsmic  PLEXUS 


Ganglion  Coccygeum  impar 

FIG.  12. — Illustrating  the  principal  communications  between  the  sympathetic 
and  cerebro-spinal  nervous  system  (Flower,  modified  by  Morris). 


Spondylotherapy 

reflexes  like  intestinal  peristalsis,  contraction  and  dilation  of 
the  arteries  and  the  secretory  activity  of  the  digestive  glands. 
The  sympathetic  system  communicates  with  the  cerebro- 
spinal  system,  by  means  of  efferent  and  afferent  nerves. 
Fig.  12  shows  the  principal  communications  between  the 
two  systems. 

The  sympathetic  nerves  are  now  regarded  as  carrying 
chiefly  motor  fibers,  and  their  cell-origin  is  most  probably 
the  lateral  horns  on  the  same  side  of  the  spinal  cord. 

THE  PHYSIOLOGY  OF  THE  SPINAL  CORD. 

The  spinal  cord  has  a  dual  function;  it  acts  as  an  inde- 
pendent central  organ  and  as  a  conductor  of  nervous  im- 
pulses. 

Reference  will  be  made  primarily  to  the  spinal  cord  as  a 

REFLEX  CENTER. 

A  reflex  refers  to  involuntary  production  of  activity  in  a 
part  brought  about  by  conduction  of  a  stimulus  along  an 
afferent  (sensory)  nerve  to  the  motor  cells  in  the  cord  or 
medulla.  This  stimulus  is  converted  into  an  impulse  by 
the  motor  cells,  which  impulse  is  then  conducted  to  a  part 
by  means  of  an  efferent  (motor)  nerve. 

The  mechanism  of  the  reflex  known  as  the  knee-jerk 
is  illustrated  in  Fig.  13.  To  elicit  this  reflex,  it  is  neces- 
sary to  have  an  intact  REFLEX  ARC,  otherwise  the  reflex  is 
abolished.  The  reflex  arc  is  made  up  as  follows : 

1 .  A  healthy  tendon  which,  when  struck  with  a  hammer, 
constitutes  the  peripheral  stimulus  which  is  then  conducted 
by- 

2,  an  afferent  (sensory)  nerve  along  the  posterior  roots 
to  the  anterior  horn  of  the  spinal  cord  where,  by  means  of 
the  motor  cells,  it  is  converted  into  an  impulse  which  is  then 
conducted  by  means  of 

26 


T     h 


K 


n 


J 


INHIBITING  FIBRES 
FROM 

J  CEREBRUM.  ) 

DISEASE  AFFECTING     > —-(m 
THESE  ALLOWS         I 
EXAGGERATED  REFLEXES  I 


f  CORTICAL 
I  LESIONS. 
1  SPASTIC 

[PARALYSIS 

ATAXA, 

_  — ^te.    *» 


DISEASED  OF 

MOTOR 
END-PLATES 


SHOWING  THE  MECHANISM  OF  THE  DEEP 
REFLEXES  AND  EXAMPLES  OF  THE  LESIONS 
WHICH  MAY  INCREASE  OR  ABOLISH  THEM 
AS  ILLUSTRATED  BY  THE  KNEE-JERK. 

DOTTED  CIRCLES  —  LESIONS  ABOLISHING 
THE  REFLEXES. 

BLACK  CIRCLES  =  LESIONS  EXAGGERATING 
THE  REFLEXES. 


,13- — Showing  the  -mechanism  of  the  knee-jerk;  also  the  two  chief  types 
(spastic  and  flaccid)  of  paralysis  (Butler). 


S    p     o     n     d    y    I    o     t    h     e     r    d   p    y 

3,     an  efferent  (motor)  nerve  to  a  healthy  muscle. 
The  text-books  usually  describe  the  following  reflexes : 

1.  Superficial  or  cutaneous  elicited  by  irritation  of  the 
skin  or  a  mucous  membrane  resulting  in  contraction  of  the 
muscles  contiguous  to  the  site  of  irritation; 

2.  Deep  or  tendon  reflexes  elicited  by  striking  a  tendon, 
muscle  or  periosteum  near  the  tendon; 

3.  Organic  or  visceral  reflexes  which  result  in  special 
acts  like  urination  and  defecation. 

The  reader  is  referred  to  page  7,  where  consideration 
was  given  to  the  vertebral  reflexes.  The  latter  are  essentially 
central  and  are  elicited  by  concussion  or  sinusoidalization  of 
the  spinous  processes  of  definite  vertebrae  and  by  pressure 
at  the  vertebral  exits  of  the  spinal  nerves. 

A  single  paradigm  may  be  cited  to  show  the  importance 
of  the  central  vertebral  reflexes  in  diagnosis.  In  LOCOMOTOR 
ATAXIA  the  posterior  root-fibers  in  the  posterior  columns  in 
the  lumbar  region  are  involved,  in  consequence  of  which 
the  knee-jerk*  is  diminished  or  usually  abolished. 

The  knee-jerk  would  be  similarly  influenced  in  lesions 
involving  the  anterior  horns  of  the  gray  matter  by  cutting 
off  the  motor  path.  In  other  words,  to  elicit  the  knee-jerk 
the  reflex  arc  in  the  lumbar  cord  must  be  intact.  Reference 
to  Fig.  14  shows  that  the  center  for  the  knee-jerk  is  located 
in  segment  III,  of  the  medulla  lumbalis  and  reference  to 
Fig.  4,  shows  that  the  quadriceps  reflex  (central  vertebral 
reflex)  corresponds  practically  to  the  same  site. 


*The  knee-jerk  reflex  arc  is  made  up  of  nerve-fibers  which  pass  to  and  from  the 
crureus  (one  of  the  four  muscles  constituting  the  quadriceps  extensor)  by  the 
anterior  crural  nerve  and  to  and  from  the  hamstrings  by  the  sciatic  nerve. 
The  nerves  to  the  crureus  arise  from  the  spinal  nerve-roots  corresponding  to 
the  3rd  and  4th  lumbar;  the  hamstring  supply  is  from  the  5th  lumbar  and  ist 
and  and  sacral  roots.  It  will  be  noted  that  concussion  will  not  elicit  the  knee- 
jerk.  Here  it  is  necessary  to  sinusoidalize  simultaneously  the  2nd  lumbar 
vertebra  and  the  sacral  region. 

28 


The      K     n      e     e     -     J 


e      r 


Now,  in  locomotor  ataxia,  the  knee-jerk  is  abolished, 
owing  to  involvement  of  a  part  of  the  reflex  arc  (the  afferent 
or  sensory  path),  and  when  the  knee-jerk  is  elicited  in  the 
usual  way,  it  may  be  difficult  to  say  whether  any  other  part 
of  the  arc  in  question  is  implicated.  If  one  can  provoke 
the  central  quadriceps  reflex,  one  can  at  least  conclude  that 
the  descending  paths  (efferent  or  motor)  are  intact.  For  a 
like  reason  a  peripheral  neuritis  may  be  difficult  to  differen- 
tiate from  locomotor  ataxia  owing  to  involvement  of  the 
peripheral  sensory  nerves. 

In  a  number  of  patients  with  locomotor  ataxia  examined 
by  the  author,  a  quadriceps  reflex  was  usually  present,  and 
in  a  number  of  instances  an  exaggerated  knee-jerk  was 
obtainable  on  either  one  or  the  other  leg.  Usually  it  was 
absent  in  the  more  atactic  leg  or  in  advanced  stages  of  the 
disease. 

Here  one  was  constrained  to  conclude  that  when  the 
knee-jerk  was  obtainable,  the  posterior  root-fibers  were 
not  entirely  destroyed.  It  was  also  found  that  the  Achilles 
reflex  could  be  elicited  (corresponding  to  segment  V  of  the 
medulla  lumbalis,  Fig.  14)  in  a  number  of  cases  of  loco- 
motor  ataxia  by  sinusoidalization  over  the  sacrococcygeal 
articulation. 

The  elicitation  of  the  vertebral  reflexes  directs  reference 
to  a  mooted  point  in  physiology,  viz.,  whether  the  tendon 
reflexes  are  or  are  not  true  reflexes.  According  to  the 
prevailing  opinion,  they  are  not  true  reflexes  but  are  due  to 
direct  stimulation  of  the  muscle  itself.  The  author  questions 
the  correctness  of  the  latter  observation  insomuch  as  a 
veritable  Achilles  reflex  and  knee-jerk  can  be  elicited  in 
the  norm  by  vertebral  stimulation.* 

*The  author  is  convinced  that  this  subject  embraces  a  field  of  research  of  vast  im- 
portance to  the  neurologist.  Man  is  available  for  experimentation  for,  in  the 
study  of  the  vertebral  reflexes,  they  can  be  evoked  with  an  accuracy  almost 
equal  to  their  elicitation  by  vivisection. 


S   p    o    n    d   y    loth     e    r    a    p    y 

In  eliciting  the  knee-jerk  the  large  electrode  must  be 
placed  over  the  lower  sacral  region  and  the  interrupting 
electrode  over  the  spinous  process  of  the  2nd  lumbar  vertebra 
and  one  leg  crossed  upon  the  other  leg.  A  strong  current  is 
necessary.  With  some  sinusoidal  machines  the  knee-jerk 
cannot  be  evoked,  but  with  Kellogg's  apparatus  (Fig.  44) 
it  can  practically  always  be  excited. 

LOCALIZATION   OF   FUNCTION   IN   THE   DIFFERENT   SEGMENTS 
OF  THE  SPINAL  CORD. 

A  SPINAL  SEGMENT  refers  to  the  part  of  the  cord  contained 
between  two  sets  of  roots.  Each  segment  must  be  regarded 
as  a  unit  endowed  with  motor,  sensory,  vasomotor,  trophic 
and  reflex  functions  with  regard  to  the  peripheral  distribution 
of  the  roots  of  the  nerves  which  emerge  from  and  enter  it. 
A  segment  is  called  after  the  nerve-roots  which  take  their 
origin  from  it  and  not  with  reference  to  its  relation  to  the 
vertebrae. 

A  diagrammatic  representation  of  the  spinal  cord  is  shown 
in  Fig.  14.  The  cord  is  divided  into  its  four  regions.  Within 
each  region  the  spinal  segments  are  indicated  by  numbers. 
On  the  right-hand  side  of  the  diagram,  muscles  or  groups  of 
muscles  are  indicated,  and  the  lines  proceeding  from  them 
pass  to  the  segments  of  the  cord  in  which  the  cell -bodies  of 
origin  are  located. 

On  the  left  side  of  this  diagram  the  sensory  regions  are 
indicated  and  the  lines  show  their  relation  to  the  different 
segments  of  the  cord  itself. 

To  determine  the  condition  of  the  cord  at  different  levels 
the  following  table11  is  serviceable.  It  shows  the  different 
segments  controlling  the  skeletal  muscles,  the  reflex  centers 
and  the  chief  location  of  the  segmental  skin-field. 


30 


SENSORY 


CORD 


MOTOR 


Occiput 

Neck- 
Shoulder  ' 


Musculo-spiral 
nerve | 

Median  nerve* 


Omar  nerve 


Thorax • 


Epigastrium  • 


Abdomen 
Umbilicus 


Gluteal  and  in-  > 
guinal  regions  j 
f  Anterior 
aspect 

External  > 

aspect  r* 
Posterior  | 

aspect 
Internal 

aspect 
Anterior 

aspect 

Foot* 


Thign 
and 
Hip 


Leg 


Scrotum,  penis. 
Rectum,  bladder  - 

Anus. 


Diaphragm 
Levator  anguli 
scapulae 

Sternomastoid 
Scale  ni 
Neck  muscles 
Trapezius 

*(  Supraspinatus 

Supinator  longus 
Rhomboids 

Teres  minor 

Deltoid 

Infraspinatus 

Biceps 

Subscapularis 

Coraco-brachialis 
Deep  shoulder  mus- 
cles 

Serratus  magnus 
Brachialis  anticus 
[  Pectoralis  major 
[Extensors  of  wrist 

and  fingers 
I  Teres  major 
[  La t issimus  dorsi 
f  Flexors    of     wrist 

and  fingers 
I  Triceps 

1  Extensorsof  thumb 
Muscles  of  thenar 
and  hypothenar 
eminences 

\flnterossei,   lumbri- 
l     cales 
[intercostals 

'  Muscles    of     back 
and  abdomen 

[Adduction  of  hip 

[Quadriceps 
Sartorius 

[  Dio-psoas 

External    rotators 

of  hip 

Hamstring  muscles 
Calf  muscles 
Abduction  of  hip 
Olutei 
Peronei 
Small  muscles  of 

foot 

Anterior  tibial  mus- 
cles 
Perineal  muscles 

Bladder 
Rectum 


FIG.  14. — Diagrammatic  representation  of  the  spinal  cord  showing  the  spinal 
segments  for  motion  and  sensibility.    Jakob,  Starr,  Sachs,  Dana,  Mills  and  Butler. 


S   p    o    n    d    y    I    o    t    h     e    r    a   p    y 


LOCALIZATION  OF  THE  FUNCTIONS  IN  THE  SEGMENTS  OF  THE 

SPINAL  CORD. 


SEGMENT 

STRIPED  MUSCLES 

REFLEX 

SKIN-FIELDS 

I,  II,  and  III 

C 

Splenius  capitis 

Hypochondrium  (  ?) 

Sack  of   head   to 

Hyoid  muscles 

Sudden     inspiration 

vertex. 

Sterno-mastoid 

produced  by  sudden 

Neck  (upper  part). 

Trapezius 

pressure  beneath  the 

Diaphragm  (C  HI-V) 

lower  border  of  ribs 

Levator  scapulae  (C  III- 

(diaphragmatic)  . 

V) 

IV  C  

Trapezius 

Dilation  of  the  pupil 

Neck  (lower  part 

Diaphragm 

produced   by    irrita- 

to second  rib). 

Levator  scapulae 

tion  of  neck.    Reflex 

Upper  shoulder. 

Scaleni  (C  IV-DI) 

through  the  sympa- 

Teres minor 

thetic  (C  IV-DI). 

Supraspinatus 

Rhomboid 

vc  

Diaphragm 

Scapular     (CV-DI). 

Outer      side      of 

Teres  minor 

Irritation  of  skin  over 

shoulder  and   up- 

Supra and  infra  spinatus 

the  scapula  produces 

per  arm  over  del- 

(C V-VI) 

contraction    of    the 

toid  region. 

Rhomboid 

scapular    muscles. 

Subscapularis 

Supinator  longus  and 

Deltoid 

biceps. 

Biceps 

Tapping    their    ten- 

Brachialis anticus 

dons   produces   flex- 

Supinator longus   (C  V- 

ion  of  forearm. 

VII) 

Supinator   brevis   (C   V- 

VII) 

Pectoralis   (clavicular 

sart) 

Serratus  magnus 

VIC  

Teres  minor  and  maior 

Triceps.        Tapping 

Duter  side  of  fore- 

[nfraspinatus 

elbow    tendon    pro- 

arm,    front     and 

Deltoid 

duces    extension    of 

back.     Outer  half 

Biceps 

rorearm. 

of  hand(?). 

Brachialis  anticus 

3osterior  wrist.  Tap- 

Supinator longus 

ing  tendons  causes 

Supinator  brevis 

extension    of    hand 

Pectoralis  (clavicular 

(C  VI-VII). 

>art) 

Serratus  magnus   (C   V- 

VIII) 

^oraco-brachialis 

Pronator  teres 

Triceps  (outer  and  long 

leads) 

Sxtensors  of  wrist 

(C  VI-VHI) 

32 


Segmental     Localization 


LOCALIZATION  OF  THE  FUNCTIONS  IN  THE  SEGMENTS  OF  THE 
SPINAL  CORD— CONTINUED. 


SEGMENT 

STRIPED  MUSCLES 

REFLEX 

SKIN-FIELDS 

VII  C  

Teres  major 

Scapulo-humeral. 

Inner  side  and 

Subscapularis 
Deltoid  (posterior  part) 
Pectoralis   major   (costal 
part) 
Pectoralis  minor 
Serratus  magnus 
Pronators  of  wrist 
Triceps 
Extensors    of    wrist    and 
fingers 
Flexors  of  wrist 
Latissimus  dorsi  (C  VI- 
VIII) 

Tapping  the  inner 
lower  edge  of  scap- 
ula causes  adduction 
of  the  arm.  Anterior 
wrist.  Tapping  an- 
terior tendons  causes 
flexion  of  wrist  (C 
VII-  VIII). 

back  of  arm  and 
forearm.  Radial 
half  of  the  hand. 

VIII  C  

Pectoralis   major    (costal 

Palmar.  Stroking 

Forearm  and  hand, 

part) 
Pronator  quadratus 
Flexors  of  wrist  and  fin- 
gers) 
Latissimus 
Radial    lumbricales    and 
interossei 

palm  causes  closure 
of  fingers. 

inner  half. 

ID  

Lumbricales    and    inter- 

Upper arm,  inner 

ossei 
Thenar  and   hypothenar 
eminences  (C  VII-DI) 

half. 

II  to  XII  D  .. 

Muscles  of  back  and  ab- 
domen 
Erectores    spinae    (D    I- 
LV) 
Intercostals  (D  I-D  XII) 
Rectus  abdominis  (D  V- 
DXII) 
External  oblique   (D  V- 
XII) 
Internal  oblique  (D  VII 
-LI) 
Transversalis(D  VII-LI). 

Epigastric.        Tick- 
ling mammary  region 
causes   retraction  of 
epigastrium   (D   IV- 
VII). 
Abdominal.      Strok- 
side      of      abdomen 
causes   retraction  of 
belly  (D  IX-XII). 

Skin  of  chest  and 
abdomen  in  obli- 
que dorso-ventral 
zones.  The  nipple 
lies  between  the 
zone  of  D  IV  and 
D  V.  The  um- 
bilicus lies  in  the 
field  of  D  X. 

I  L  

Lower   part    of    external 

Cremasteric  Strok- 

Skin over  lowest 

and  internal  oblique  and 
transversalis 
Quadratus  lumborum  (L 
I-II) 
C  remaster 
Psoas  major  and  minor(?) 

ing  inner  thigh  caus- 
es retraction  of  scro- 
tum (L  I-II). 

abdominal  zone 
and  groin. 

33 


Spondylotherapy 


LOCALIZATION  OF  THE  FUNCTIONS  IN  THE  SEGMENTS  OF  THE 
SPINAL  CORD— CONTINUED. 


SEGMENT 

STRIPED  MUSCLES 

REFLEX 

SKIN-FIELDS 

II  L  

PSOES  major  and  minor 

Front  of  thigh. 

Iliacus 
Pectineus 
Sartorius  (lower  part) 
Flexors  of  knee  (Remak) 
Adductor  longus  and  bre- 
vis 

Ill  L  

Sartorius  (lower  part) 

Patellar  tendon. 

Front    and    inner 

Adductors  of  thigh 
Quadriceps    femoris    (L 
II-L  IV) 
Inner  rotators  of  thigh 
Abductors  of  thigh 

Tapping    tendon 
causes   extension   of 
leg. 
"Knee-jerk" 

side  of  thigh. 

IV  L  

Flexors  of  knee  (Ferrier) 

Gluteal.  Stroking 

Mainly  inner  side 

Quadriceps  femoris 
Adductors  of  thigh 
Abductors  of  thigh 
Extensors  of  ankle  (tibi- 
alis  anticus) 
Glutei  (medius  and  mi- 
nor) 

buttock  causes  dimp- 
ling in  fold  of  but- 
tock (L  IV-V). 

of  thigh  and  leg  to 
ankle. 

VL  

Flexors    of    knee    (ham- 

Back  of   leg   and 

string  muscles)   (L  IV-S 
H) 
Outward  rotators  of  thigh 
Glutei 
Flexors    of    ankle    (gas- 
trocnemius    and    soleus) 
(L  IV-S  II) 
Extensors  of  toes  (L  IV- 

si) 

Peronaei 

part  of  foot. 

I  to  II  S  

Flexors  of  ankle  (L  V-S 

Foot  reflex  Exten- 

Back of  thigh   leg 

II) 
Long  flexor  of  toes  (L  V- 
SII) 
Peronaei 
Intrinsic  muscles  of  foot 

sion  of  Achilles  ten- 
don causes  flexion  of 
of  ankle  (S  I-II). 
Ankle-clonus.  Plan- 
tar. Tickling  sole 
foot  causes  flexion  of 
toes  or  extension  of 
great  toe  and  flexion 
of  others. 

and     foot;     outer 
side. 

IlltoVS  1 

'erineal  muscles.   Levator 
and  sphincter  ani  (S  I- 
HI) 

Vesical  and  anal  re- 
flexes. 

Skin  over  sacrum 
and  buttock. 
Anus. 
Perinaeum.    Geni- 
tals. 

S  e  g  m   e   n   t  a   I    K  k'  i  n  -  F  i  e  Ids 


.0.67 


FIG.  15. — Showing  the  areas  on  both  surfaces  of  the  body  which  Are  related  to 
the  different  segments  of  the  spinal  cord.  When  a  segment  of  the  cord  is  destroyed, 
the  surface  of  the  body  is  anesthetic  in  the  area  corresponding  to  that  segment. 
C,  cervical;  D,  dorsal  or  thoracic;  L,  lumbar,  S,  sacral. 


35 


Spondyloth 


a    p    y 


Fig.  15  shows  the  segmental  skin-fields  which  assist  in 
determining  the  segmental  level  of  spinal  cord  and  of 
dorsal  root-lesions. 

VISCERO -MOTOR  CENTERS. 

It  will  be  noted  that  the  following  physiologic  location  of 
the  viscero-motor  cells  does  not  correspond  with  the  clinical 
localization  of  the  viscero-motor  reflexes  (Fig.  5).  However, 
the  former  are  cited  for  the  sake  of  completeness.  It  will 
also  be  observed  that  the  clinical  evidence  tallies  with 
physiologic  observation,  viz.,  that  there  is  usually  a 
double  viscero-motor  mechanism  consisting  of  excitation  and 
inhibition. 

TABLE  OF  THE  VISCERO-MOTOR  CENTERS. 


STRUCTURE. 


LOCATION  OF  VISCERO-MOTOR 
CELLS. 


Pupil  (constriction  of). 
Pupil  (dilatation  of). 


Nucleus  of  the  3rd  cranial  nerve. 
Between  the  6th  cervical  and  2nd 

dorsal  segments. 
Bronchi  and  bronchioles  (constric-     Nucleus  of  the  loth  cranial  nerve. 

tion  of). 

Heart  (acceleration  of).  6th  cervical  to  the  2nd  dorsal  seg- 

ments of  the  cord. 

Heart  (inhibition  of).  Nuclei  of  the  loth  and  nth  cra- 

nial nerves. 
Alimentary     canal     (accelerating     Nucleus  of  the  xoth  cranial  nerve. 

peristaltic  movements) . 
Alimentary    canal    (inhibition    of     4th  dorsal  to  the  2nd  lumbar  seg- 

peristaltic  movements).  ments. 

Uterus    (inhibition    of    muscular     2nd,  3d  and 4th  lumbar  segments, 
coat  and  contraction  of  the  cer- 
vix and  vagina). 
Dilatation    of    cervix    uteri    and     2nd,  3d  and  4th  sacral  segments. 

vagina. 
Bladder  (contraction  of  the  sphin-     2nd,  3d  and  4th  lumbar  segments. 

cter) . 

Bladder  (relaxation  of  the  sphin-     2nd,  3d  and  4th  sacral  segments. 
cter). 


Relation    of  Spines    to    Segments 

By  referring  to  Fig.  10  the  physician  will  be  able  to 
determine  the  relation  of  the  segments  of  the  spinal  cord  to 
the  spines  of  the  vertebrae.  It  may  be  recalled  that  a  seg- 
ment is  called  after  the  pair  of  nerves  which  arise  from  it 
and  not  from  its  vertebral  relation.  The  following  table 
shows  the  approximate  relation  of  the  spines  of  the  vertebrae 
to  the  segments  of  the  spinal  cord. 

APPROXIMATE  RELATION  OF  THE  VERTEBRAL  SPINES 
TO  THE  SPINAL  SEGMENTS. 

CERVICAL  SEGMENTS.  VERTEBRAL  SPINES. 

TT  \  ..................  ist  cervical  spinous  process. 

HI  I  ..................  2nd  cervical  spinous  process. 

V  ....................  3d  cervical  spinous  process. 

VI  ....................  4th  cervical  spinous  process. 

TTJ  TT  I  ..................  5th  cervical  spinous  process. 

DORSAL  SEGMENTS. 

-6th  cervical  spinous  process. 


III  ....................  yth  cervical  spinous  process. 

IV  ....................  ist  dorsal  spinous  process. 

V  ....................  2nd  dorsal  spinous  process. 

VI  ....................  3d  dorsal  spinous  process. 

VII  ....................  4th  dorsal  spinous  process. 

VIII  ....................  5th  dorsal  spinous  process. 

IX  ....................  5th  dorsal  spinous  process. 

X  ....................  6th  dorsal  spinous  process. 

XI  ....................  7th  dorsal  spinous  process. 

XII  ....................  8th  dorsal  spinous  process. 

LUMBAR  SEGMENTS. 

1  ....................  9th  dorsal  spinous  process. 

TTT  \  .................  loth  dorsal  spinous  process. 

i  ith  dorsal  spinous  process. 


SACRAL  SEGMENTS. 

'      an  ,         \  .................  1  2th  dorsal  spinous  process. 


, 

COCCYGEAL  SEGMENT. 

I  ....................  ist  lumbar  spinous  process. 

The  vaso-motor  apparatus  is  discussed  on  page  272. 


S    p     ondylotherapy 


CHAPTER  III. 

SYMPTOMATOLOGY. 

EXAMINATION  OF  THE  BACK — THE  NORMAL  SPINE — DISEASES  OF  THE 
SPINE — SPONDYLOGRAPHY — EXAMINATION  OF  THE  MUSCLES  OF 
THE  BACK — STIFF  BACK — MUSCULAR  HYPOTONIA — PAIN  AND 
TENDERNESS  OF  THE  SPINE — SYMPATHETIC  SENSATIONS — DERMA- 
TOMES  OF  HEAD — VERTEBRAL  PAIN — VERTEBRAL  TENDERNESS — 
VERTEBRAL  PERCUSSION — VIBROSUPPRESSION. 

The  VERTEBRAL  COLUMN  subserves  the  following  objects : 

1.  It  is  the  central  pillar  of  the  body  and  supports  the 

weight  of  the  head; 

2.  It  connects  the  upper  and  lower  segments  of  the 

trunk  and  gives  attachments  to  the  ribs. 

3.  It  diminishes  the  effects  of  shocks  conveyed  from 

various  parts  of  the  body  chiefly  by  means  of  its 
curves  and  the  elastic  intervertebral  discs  which 
act  the  part  of  buffers.* 

4.  It  is  endowed  with  considerable  mobility  and  fur- 

nishes a  solid  tube  for  the  spinal  cord. 

The  MUSCLES  of  the  back  and  trunk  are  the  only  agents 
in  supporting  the  spine  erect.  When  the  muscles  in  question 
are  exhausted,  relief  is  involuntarily  secured  by  means  of 
rotation  and  lateral  flexion,  thus  eventuating  in  the  condition 
known  as  scoliosis. 

THE  NORMAL  SPINE. 

The  normal  spine  must  be  studied  with  relation  to  its 
CONTOUR  and  FLEXIBILITY.  Any  deviation  of  the  spinous 

*If  the  height  of  an  individual  is  taken  in  the  morning  and  again  at  night  a  decrease 
in  the  total  height  of  the  body  of  from  i  to  2  cm.  during  the  day  will  be  noted. 
This  fact  may  be  attributed  to  compression  of  the  intervertebral  discs  by  the 
weight  of  the  body  in  the  erect  posture. 

38 


The        Normal        Spine 

processes  from  the  median  plane  of  the  body  may  be  deter- 
mined by  marking  each  spinous  process  with  a  pencil  while 
the  patient  stands  erect.  In  the  norm  the  marks  represent  a 
straight  line.  The  median  line  of  the  body  is  obtained  by 
holding  a  plumb-line  behind  the  patient  so  that  the  lower 
end  of  the  line  dips  into  the  groove  between  the  buttocks. 
In  the  norm  each  marked  spinous  process  will  lie  under  the 
plumb-line. 

A  record  may  be  made  by  placing  crinoline  gauze  or 
tracing  paper  on  the  back  through  which  the  spinal  marks 
may  be  seen  and  thus  transferring  the  marks  to  the  gauze  or 
paper. 

The  contour  of  the  spine  may  be  determined  by  means 
of  a  strip  of  lead  or  pure  tin  thick  enough  so  that  it  can  be 
molded  on  the  spine  and  still  preserve  its  shape  when  re- 
moved. The  prominent  spinous  processes  should  be  indicated 
upon  it.  The  curves  of  the  spine  thus  obtained  may  be 
transferred  to  paper  for  further  study. 

Certain  curves  are  constant,  viz. : 

1.  Forward  in  the  upper; 

2.  Backward  in  the  middle,  and 

3.  Again  forward  in  the  lower  region. 

These  curves  are  fixed  in  the  adult  but  may  be  almost 
annihilated  in  early  childhood  by  traction  in  the  horizontal 
position. 

In  the  erect  posture  a  normal  individual  will  show  the 
following  curves  (Fig.  16): 

1.  Cervical,  the  convexity  of  which  is  forward.     It 

begins  at  the  ist  cervical  and  ends  at  the  2nd 
dorsal  vertebra; 

2.  Thoracic  or  dorsal,  the  convexity  of  which  is  back- 

ward.    It  begins  at  the  3d  dorsal  and  ends  at  the 

39 


Spondyloth 


r    a   p    y 


1 2th  dorsal  vertebra;  its  most  prominent  point 
behind  corresponds  to  the  spine  of  the  7th  dorsal. 

Lumbar,  which  is  convex  anteriorly,  commences  at 
the  middle  of  the  last  dorsal  vertebra  and  ends 
at  the  sacro-vertebral  angle.  This  curve  is  more 
marked  in  the  female  than  in  the  male. 

Pelvic,  which  is  concave  anteriorly,  commences  at 
the  sacro-vertebral  articulation  and  ends  at  the 
point  of  the  coccyx. 


FlG.  16. — Normal  vertebral  curves  and  divisions  of  the  spine  (Whitman). 

The  average  length  of  the  spinal  column  in  the  male  is 
about  2  feet  and  4  inches  and  the  female  spine  is  about  2  feet 
in  length.  The  length  of  the  individual  parts  is  as  follows : 

1.  Cervical 5  inches 

2.  Dorsal n       " 

3.  Lumbar 7       u 

4.  Sacrum  and  coccyx 5       " 

40 


The        Normal        S  p 


/    n    e 


In  the  adult  many  causes,  notably  occupations,  cause 
variations  of  the  normal  contour  of  the  spine,  but  in  children 
such  variations  may  be  regarded  as  abnormal. 

The  normal  contour  results  from  balancing  of  the  body 
in  the  erect  posture,  and  if  there  is  any  variation  in  one  part 
compensation  induces  a  change  in  another  part,  eventuating 
often  in  a  complete  reversal  of  the  normal  spinal  curves. 

Even  in  the  norm  there  is  a  slight  lateral  convex  curve 
to  the  right,  extending  from  the  5th  dorsal  to  about  the  3d 
lumbar  vertebra,  which  has  been  attributed  to  the  following 
causes : 

1.  Aortic  pressure  on  the  vertebral  bodies; 

2.  Excessive  use  of  the  right  side  of  the  body; 

3.  Right-handedness. 

The  FLEXIBILITY  of  the  human  spine  is  largely  dependent 
on  movements  between  the  spine  and  the  pelvis  and  the 
head. 

It  is  evident  that  exercises  destined  for  the  spine  only 
must  presume  pelvic  fixation,  for  otherwise,  as  Lovett12  puts 
it,  "Part  of  the  muscular  force  is  used  in  displacing  the  pelvis 
to  the  opposite  side  to  balance  the  body  and  the  movement 
becomes  a  general  and  not  a  spinal  one." 

The  MOVEMENTS  of  the  spine  are : 

1.  Flexion;  3.     Lateral  flexion; 

2.  Extension;  4.     Rotation. 

In  FLEXION,  or  forward -bend  ing,  if  extreme  and  perfect, 
the  spinous  processes  will  describe  the  arc  of  a  circle  and  the 
distance  by  measurement  from  the  yth  cervical  vertebra  to 
the  sacrum  is  greater  than  a  like  measurement  secured  in 
the  erect  or  prone  posture. 

In  EXTENSION,  or  backward -bending,  the  movement  is 
chiefly  limited  to  the  lumbar  and  the  last  two  dorsal  verte- 

41 


S  p 


o    n 


d   y    loth 


a    p    y 


brae.  In  hyperextension,  if  measurement  is  made  of  the 
distance  from  the  yth  cervical  vertebra  to  the  sacrum  (over 
the  spinous  processes),  it  is  decreased  when  compared  with 
a  like  measurement  in  the  erect  posture. 

LATERAL  FLEXION  may  be  tested  by  side -bending  in  the 
erect  posture.  In  the  norm  the  movement  is  located  at  and 
below  the  lumbar  dorsal  junction. 

ROTATION  is  most  pronounced  in  the  erect  posture  in  the 


TRANSMITTED  AORTIC  PULSATIONS     DORSAL  REGION 


FIG.  17. — Spondylograms  reduced  one-half.  A,  taken  at  the  level  of  the  yth 
cervical  spine;  B,  taken  in  the  dorsal  region;  C,  taken  in  the  lumbar  region;  D, 
transmitted  aortic  pulsations  taken  in  the  dorsal  region  during  the  time  the  patient 
suspends  respiration. 

cervical  and  dorsal  regions ;  the  maximum  is  attained  at  the 
top  of  the  cervical  column  extending  below  to  the  lower 
dorsal  region  where  it  is  no  longer  evident. 

SPOND  YLOGRAPHY . 

It  is  generally  contended  that  the  spinal  column  enjoys 
a  considerable  range  of  motion  as  a  whole,  but  that  the 
motion  between  any  two  individual  pieces  is  extremely 

42 


S    p     ondylography 

limited.  It  is  known  that  during  deep  respiration  a  straight- 
ening of  the  vertebral  column  occurs  involuntarily.  The 
author  has  reason  to  believe  that  the  vertebrae  en  joy  a  greater 
degree  of  motion  than  is  usually  accepted  and  to  prove  this 


FIG.  18. — Apparatus  for  taking  a  spondylogram.  The  position  of  the  patient 
is  adapted  for  taking  tracings  of  the  abdominal  aorta.  To  take  a  spondylogram 
the  patient  must  be  in  the  prone  position.  A,  stand  with  an  adjustable  rod,  B; 
C,  lever;  D,  tambour  for  recording.  To  the  short  end  of  lever  (C),  a  string  is 
passed  through  an  opening  and  the  end  of  the  string  is  fixed  by  adhesive  plaster 
to  a  spinous  process. 

contention  the  accompanying  spondylograms  are  submitted 
(Fig.  17). 

They  were  obtained  with  the  patients  in  the  prone 
posture  during  quiet  breathing.  The  serrations  noted  in 

43 


Spondylotherapy 

the  tracings  are  probably  transmitted  aortic  pulsations.  The 
apparatus  (Fig.  18)  employed  for  eliciting  the  spondylo- 
grams  was  originally  constructed  by  the  author  for  taking 
tracings  of  the  abdominal  aorta.32 

Spondylography  will  aid  in  the  early  diagnosis  of  respir- 
atory vertebral  immobility  and  by  furnishing  a  permanent 
record,  the  course  of  a  vertebral  disease  may  be  accurately 
controlled.  Here  we  are  in  the  possession  of  a  method  which 
may  be  as  important  to  the  orthopedist  as  is  the  sphygmo- 
graph  to  trie  clinician. 

DISEASES  OF  THE  SPINE. 
SPINAL   EXAMINATION   FOR   DEFORMITY. 

With  the  patient  in  the  erect  position  (heels  together  and 
arms  hanging)  note  if  the  curves  are  normal  or  if  there  is 
any  abrupt  projection  of  one  or  more  spines. 

Any  ROTATION  of  the  vertebrae  may  be  determined  by 
comparing  the  prominence  of  the  angles  of  the  ribs,  the  trans- 
verse processes  of  the  lumbar  vertebras,  the  height  and 
prominence  of  the  scapulae  and  the  prominence  of  the  iliac 
crests  on  the  two  sides.  Estimation  of  rotation  or  twist  is 
best  determined  by  Adam's  position:  The  patient  bends 
forwards  (with  unflexed  knees)  until  the  trunk  is  horizontal 
with  the  hands  hanging  down.  With  the  head  on  a  level 
with  the  spine  the  physician  notes  whether  either  side  of  the 
trunk  is  more  prominent  upward.  The  presence  of  an  up- 
ward prominence '  indicates  rotation  or  twist.  Next,  the 
anterior  aspect  of  the  body  is  inspected  and  the  following 
noted  with  reference  to  the  two  sides  of  the  body ;  deformities 
of  the  chest  and  the  level  of  both  anterior  iliac  spines.  Again, 
inspecting  the  back,  the  patient  is  instructed  to  bend  forward 
(with  knees  straight)  and  note  should  be  made  if  he  bends 
freely  and  straight  forwards.  If  the  movement,  however,  is 

44 


Examination    for    D  efo  rmity 


restricted  and  oblique  and  if  the  angles  of  the  ribs  are  un- 
covered by  the  scapulae  and  project  more  on  one  side,  one 
is  dealing  with  signs  of  ROTATION  OF  THE  SPINE.  The 
presence  and  degree  of  this  rotation  determine  the  diagnosis 
of  Scoliosis  and  not,  as  Gould13  emphasizes,  the  lateral 
deviation  of  the  tips  of  the  spinous  processes.  Next,  the 
patient  assumes  the  prone  posture  on  a  flat  couch.  In  the 
latter  position  the  following  may  be  noted : 


CURVES. 

Natural  curves  lost  and  replaced 
by  a  general  convexity  of  the 
spine  backwards  altered  by 
movement  and  disappearing  in 
the  recumbent  posture. 

The  general  convexity  of  the  spine 
backwards  is  permanent  and  un- 
influenced by  movement  or  the 
recumbent  position  and  the 
movements  of  the  spine  are 
diminished. 

There  is  an  abrupt  curve  of  the 
spine  backwards  or  several  spin- 
ous processes  are  projected  pos- 
teriorly. 

Diminution  of  the  natural  curve  in 
the  dorsal  region  with  straight 
dorsal  spine  sunk  in  between  the 
scapulae  and  rotation  of  the 
spine. 

Lateral  deviation  of  the  spines 
without  rotation  and  disappear- 
ance of  the  deviation  in  the  re- 
cumbent position. 

A  permanent  (uninfluenced  by 
position)  long  sweeping  curve  to 
one  side  without  rotation  of  the 
vertebrae. 


AFFECTION. 

Spinal    muscular    debility    from 
rickets  or  other  causes  and  in 
convalescents  who  have  main 
tained  the  horizontal  posture. 

Spondylitis  deformans. 


Caries  of  the  spine  (Pott's  disease). 


Lateral    curvature   of   the   spine 
(scoliosis) . 


Weak-spine  often  present  in  hys- 
teria. 


Retraction  of  chest  observed  in 
pleuritis  and  empyema. 


45 


S  p     o     n     d    y     I    o     the     r    a    p    y 


EXAMINATION  OF  THE  MUSCLES   OF  THE  BACK. 

"The  spine  lies  at  the  back  of  a  more  or  less  cylindrical 
muscular  tube  of  which  the  abdominal  muscles  form  the 
front"  (Lovett12). 

There  are  two  kinds  of  muscles  directly  attached  to  the 
back,  one  group  passing  from  one  part  of  the  spine  to  another 
part  and  to  the  head  and  another  group  running  from  the 
spine  to  the  pelvis  or  shoulder  girdle. 

In  diagnosis  and  in  treatment  by  muscular  exercises,  the 
fact  must  be  emphasized  that  the  spinal  movements  are  not 
affected  by  an  individual  muscle  but  by  all  the  spinal  muscles 
which  act  in  unison. 

The  relative  rigidity  of  the  thoracic  spine  is  dependent  on 
the  attachment  of  the  ribs  behind,  between  two  vertebrae 
and  to  the  sternum  in  front. 

There  are  two  feeble  and  movable  parts  of  the  spine 
(points  where  important  muscles  have  a  dividing  line),  viz. : 

1.  At  the  cervico-dorsal  junction; 

2.  At  the  dorsolumbar  junction. 


The  ligaments  of  the  spine  are  loose  and  the  surfaces  of 
the  articular  processes  are  only  in  slight  contact,  hence  the 
muscles  of  the  back  and  trunk  are  the  only  agents  for  main- 
taining the  spine  erect.  The  moment  the  muscles  are  ex- 
hausted some  relief  is  obtained  by  rotation  and  lateral  flexion 
of  the  spinal  column  (which  tightens  the  ligaments  and 
brings  the  articular  processes  in  closer  contact)  which 
eventuates  in  scoliosis. 

RIGIDITY  OF  THE  SPINAL  MUSCLES. 

The  condition  of  the  spinal  muscles  may  be  determined 
by  the  movements  of  the  patient  and  by  palpation.  The 

46 


S    p     in     al-Muscles 

former  may  be  tested  by  directing  the  subject  to  jump,  run, 
walk,  pick  up  objects  from  the  floor,  etc. 

The  tests  must  include  movements  which  necessitate 
flexion,  extension  and  lateral  bending  of  the  spine. 

By  placing  the  palm  of  the  hand  on  various  parts  of  the 
spine  and  then  directing  the  patient  to  make  different 
motions,  one  may  note  during  execution  of  the  latter  whether 
the  vertebrae  move  or  are  fixed. 

Special  movements  exclude  definite  joint-involvement. 

Free  and  painless  nodding  of  the  head  excludes  implica- 
tion of  the  occipito-atloid  joint. 

If  the  face  can  be  easily  turned  from  one  side  to  another 
the  atlo-axoid  joint  is  not  involved. 

The  lower  cervical  spine  is  not  implicated  if  flexion  of 
the  head  can  be  executed  freely  and  painlessly. 

The  various  voluntary  movements  must  be  adapted  to 
the  intelligence  of  the  patient.  Thus  children  who  resist 
passive  movements  on  a  table  will  submit  to  manipulation  in 
the  arms  of  the  mother. 

A  child  will  walk  toward  its  mother  and  will  incline  the 
head  in  the  direction  of  the  latter — a  useful  test  in  determining 
the  condition  of  the  cervical  spine. 

By  placing  the  patient  in  a  recumbent  position  (with 
head  slightly  elevated),  first  on  the  right  and  then  on  the 
left  side,  the  spinal  muscles  are  relaxed  and  may  be  care- 
fully palpated. 

In  the  norm  the  muscles  show  no  tenderness,  are  elastic 
and  easily  roll  under  the  palpating  finger. 

SPASM  OF  THE  SPINAL  MUSCLE. 

By  the  term  "spasm"  one  refers  to  an  abnormal  muscular 
contraction  due  to  an  augmented  reaction  of  the  motor  nerves. 
When  the  muscular  contraction  is  prolonged  it  is  known  as 

47 


S    p     ondylotherapy 

a  tonic  spasm,  in  contradistinction  to  a  clonic  spasm,  in 
which  contractions  of  brief  duration  alternate  with  flaccid 
conditions  of  the  muscle. 

Spasm  of  the  spinal  musculature  such  as  the  author  con- 
ceives the  condition  must  be  dissociated  by  the  reader  from 
the  conventional  twitchings  and  spasmodic  movements  of 
individual  muscles  or  groups  of  muscles. 

It  is  true  that,  the  clinician  has  long  recognized  the  almost 
intelligent  function  of  muscles  whether  displayed  in  fixing  a 
diseased  joint  or  spine,  or  in  protecting  an  inflamed  serous 
membrane,  but  he  has  neglected  to  carefully  palpate  the 
spinal  musculature  for  localized  spasms  which  are  usually 
tonic  in  character. 

To  detect  such  muscular  contractions  the  patient  must 
be  placed  on  a  table  in  the  lateral  posture  to  secure  muscular 
relaxation. 

The  investigations  of  the  author  show  that  pressure  at 
the  vertebral  exits  of  the  spinal  nerves  will  elicit  muscular 
contractions  in  definite  regions,  and  conversely,  that  pressure 
in  the  latter  situations  will  evoke  localized  clonic  or  tonic 
spasm  in  definite  spinal  regions. 

In  disease  the  peripheral  localized  spasm  may  be  present 
independent  of -the  spinal  spasm,  but,  as  a  rule,  careful 
palpation  of  the  spinal  and  peripheral  musculature  demon- 
strates that  they  coexist. 

In  the  accompanying  illustration  (Fig.  19),  the  author 
has  endeavored  to  present  a  composite  picture  as  obtained 
in  the  norm. 

The  illustration  shows  the  vertebral  area  involved  in 
spasm  during  the  time  firm  pressure  is  made  in  definite 
peripheral  regions.  Pressure  made  at  these  vertebral  exits 
will  provoke  spasm  of  the  peripheral  musculature.  The  verte- 
bral areas  are  only  approximately  correct  insomuch  as  the 

48 


S    p 


n     a     I    -    M     u     s     c     I 


spasm  of  the  spinal  musculature  is  often  diffused  and  exact 
localization  is  often  impossible.  The  palpating  finger  may 
only  feel  a  tremor  or  a  sensation  like  a  pulsation  in  the 
muscle.  Not  infrequently  the  contraction  of  the  spinal 
muscle  may  be  seen. 

It  will  be  noted  that  although  pressure  is  only  made  on 


7M/&H 


FIG.  19. — Vertebral  areas  involved  in  muscular  spasm  when  different  periph- 
eral regions  are  firmly  compressed  or  irritated. 

one  side  of  the  spinal  column  the  muscular  contraction  is 
often  bilateral.  If  deep  and  firm  pressure  with  the  fingers 
of  one  hand  is  made  on  any  of  the  peripheral  points  of 
spasm,  the  other  hand  will  usually  detect  bilateral  localized 
spasm  of  the  spinal  musculature  corresponding  to  the 
vertebral  areas  indicated  in  Fig.  19. 

While  mere  cutaneous  irritation  will  induce  contraction 

49 


Spondylotherapy 

of  the  spinal  muscles,  the  latter  is  less  evident  than  when 
deep  pressure  is  made  on  the  peripheral  muscles  or  when 
the  peripheral  area  is  painful.  The  recognition  of  these 
peripheral  and  spinal  spasms  is  destined  to  be  of  considerable 
value  in  diagnosis. 

Space  will  not  permit  the  author  to  descant  further  on 
this  subject,  but  he  may  be  permitted  to  cite  meningismus  as 
a  paradigm. 

The  latter  affection  occurs  in  association  with  suppurative 
diseases  of  the  middle  ear  in  children  and  adults  and  symp- 
toms are  present  (notably  rigidity  of  the  neck-muscles) 
which  simulate  disease  of  the  brain  although  no  intracranial 
inflammation  exists. 

If  the  peripheral  source  of  irritation  can  be  inhibited  by 
means  of  cocain,  the  rigidity  of  the  neck -muscles  will  subside 
temporarily.  Reference  to  the  accompanying  illustration 
(Fig.  20)  shows  the  extensive  anastomoses  of  the  cervical 
plexus  and  explains  the  frequency  (when  sought)  of  rigidity 
of  the  neck  muscles  in  affections  of  the  head  and  face. 

There  must  also  be  a  spasm  of  the  spinal  musculature  as 
an  expression  of  visceral  disease  and  this  is  a  subject  worthy 
of  investigation. 

At  present,  however,  we  must  rely  on  vertebral  tenderness 
and  the  dermatomes  of  Head  as  indices  of  visceral  disease 
(page  58). 

STIFF  BACK. 

Stiffness  and  lack  of  mobility  of  the  back  may  be  caused 
by: 

1.  Pain  (lumbago,  vertebral  disease,  tonic  spasm  of  the 

muscles) ; 

2.  Ankylosis  of  the  vertebral  column. 

MUSCULAR  RIGIDITY  is  one  of  the  earliest  signs  of  Pott's 
disease  and  persists  until  cure  is  effected.  It  is  most  pro- 

50 


Cervical        Plexus 


FIG.  20.-  -Plan  of  the  ceivi  al  plexus  (Gray)- 


Spondyloth     e     r    a    p    y 

nounced  in  the  neighborhood  of  the  disease,  but  may  extend 
some  distance.  If  the  patient  is  directed  to  bend  forward 
and  no  rigidity  nor  spasm  is  associated  with  the  movement 
and  the  outline  of  the  spinal  curve  is  even  and  not  broken, 
Pott's  disease  may  be  safely  excluded. 

Muscular  rigidity  dissociated  with  spinal  disease  resists 
motion  only  in  the  directions  directly  opposed  by  the  con- 
traction of  the  muscles.  If  the  spasm,  however,  is  associated 
with  spinal  disease  it  resists  motion  in  all  directions. 

A  stiff  back  due  to  ankylosis  of  the  vertebral  column  may 
be  caused  by  any  of  the  following  diseases  (q.  v. ) :  Spondy- 
litis,  Pott's  disease,  paralysis  agitans  and  arthritis  deformans. 

MUSCULAR  HYPOTONIA. 

MUSCULAR  FATIGUE  is  an  invariable  sign  of  neurasthenia. 
Fatigue  of  muscle  is  caused  essentially  by  the  consumption 
of  material  necessary  for  contraction  and  the  storing  up  in 
the  muscle  of  waste -products  produced  by  its 'own  activity. 
Some  people  tire  more  easily  than  others,  owing  to  the  fact 
that  the  waste -products  responsible  for  the  fatigue  in  the 
one  are  less  readily  removed  or  accumulate  more  easily. 

Massage  of  the  muscles  rapidly  removes  the  evidence  of 
fatigue  simply  because  the  waste -products  are  washed  into 
the  circulation  by  this  manceuver. 

The  fatigue  in  neurasthenia  probably  has  its  origin  in  the 
nervous  system  and  only  indirectly  in  the  muscles. 

If  one  tests  the  strength  of  the  muscles  in  neurasthenia, 
although  a  diminished  response  is  shown,  it  is  by  no  means 
proportionate  to  the  diminished  vigor  exhibited  by  the 
patient. 

It  has  been  shown  that  the  time  during  which  an  indi- 
vidual can  sustain  a  voluntary  muscular  contraction  is  deter- 
mined by  the  endurance  of  the  brain -centers  engaged  in  the 

52 


Muscular      Hypotonia 

act  of  volition  rather  than  by  that  of  the  muscles  themselves. 
The  very  moment  these  centers  are  exhausted  the  contraction 
of  the  muscle  gives  way. 

Volition  can  be  fatigued  when  exerted  in  imagination  as 
well  as  in  actual  muscle -effort. 

BACKACHE,  or  a  sensation  of  weariness,  is  a  frequent 
symptom  of  neurasthenia  and  the  older  writers  referred  to 
this  sign  as  spinal  irritation  (vide  neurotic  spine).  It  is 
known  that  when  fatigue -signs  are  exaggerated  they  become 
painful  and  are  described  as  "aches." 

Many  cases  of  backache  in  neurasthenics  are  caused 
by  a  faulty  spinal  attitude.  Thus  the  attitude  of  chil- 
dren with  round  shoulders  (page  96)  will  substitute  lig- 
amentous  for  muscular  support.  All  our  muscular  groups 
are  not  equally  and  symmetrically  developed  and  many  de- 
formities such  as  spinal  curvatures,  round  shoulders,  etc., 
bear  witness  to  the  truth  of  the  foregoing  statement  (vide 
Exercises). 

Decrease  in  the  normal  tone  or  elasticity  of  the  muscles 
is  designated  by  the  word  HYPOTONIA,  and  this  condition  is 
frequent  in  many  nervous  diseases. 

It  is  difficult  to  measure  muscular-force.  The  dyna- 
mometer and  the  ergograph  yield  valuable  but  inconstant 
information. 

The  muscles  may  be  tested  by  noting  the  strength  of 
the  Galvanic  current  (read  in  milliamperes)  and  Faradic 
current  (measurement  on  the  scale  of  the  secondary  spiral 
and  expressed  in  millimeters  of  coil-distance)  necessary  to 
produce  the  minimal  contraction. 

The  muscles  of  the  healthy  side  may  be  used  as  a  standard 
of  comparison,  otherwise  we  must  be  governed  by  the  re- 
actions observed  in  the  average  individual  with  normal 
musculature. 

53 


S   p    o     n    d    y    I    o     t    h     e     r    a    p    y 

One  notes  that  when  the  muscles  are  weak,  with  the 
strongest  current  the  contraction  of  the  muscles  may  be  no 
greater  than  with  weak  currents. 

The  implicated  muscles  do  not  contract  in  ioto,  but  only 
a  few  bundles  contract  and  appear  as  slightly  prominent 
ridges. 

The  Faradic  current  provokes  no  tetany,  but  only  several 
clonic  contractions  of  the  muscle -substance  which  succeed 
each  other  during  the  closure  of  the  current  (myoclonic 
contractions). 

For  strengthening  defective  spinal  muscles  the  sinusoidal 
current  (page  151)  is  very  effective. 

Very  frequently  individual  muscle-groups  are  involved  in 
hypotonia.  Thus  a  faulty  position  of  the  scapulae  may  be 
caused  by  the  muscles  which  maintain  the  position  of  the 
latter.  Similarly,  scoliosis  may  be  provoked  by  an  heredi- 
tary hypotonia  of  the  spinal  muscles. 

A  lack  of  tone  or  relaxation  of  the  muscles  is  an  early 
sign14  of  LOCOMOTOR  ATAXIA.  This  hypotonia  may  be 
estimated  as  follows :  With  the  patient  in  the  erect  position 
the  distance  from  the  floor  to  the  greater  trochanter  and  the 
yth  cervical  vertebra  is  measured.  If  the  patient  is  now 
instructed  to  bend  forward  (knees  stiff)  as  far  as  possible 
and  the  distance  in  this  position  is  again  estimated  from  the 
floor  to  the  yth  cervical  vertebra,  it  will  be  found  that  in 
health,  and  in  all  affections  (excepting  tabes),  it  is  impossible 
to  bend  the  trunk  sufficiently  forward  to  permit  the  yth 
cervical  vertebra  to  be  brought  to  or  below  the  level  of  the 
trochanter.  The  hypotonia  of  the  muscles  in  tabes,  however, 
permits  the  vertebra  in  question  to  attain  a  distance  of  21 
or  more  cm.  below  the  level  of  the  trochanter. 


54 


ain-Perception 


PAIN. 

Pain  results  from  powerful  stimulation  of  a  nerve,  and 
in  accordance  with  the  law  of  eccentric  projection,  it  is  a 
matter  of  little  moment  which  part  of  the  nerve  is  stimulated, 
the  perception  of  pain  being  referred  to  the  periphery. 

According  to  the  prevailing  hypothesis  pain-perception  is 
the  result  of  individual  stimulations  which  accumulate  prob- 
ably in  the  cells  in  the  posterior  part  of  the  gray  substance 
of  the  spinal  cord  and  it  is  the  total  of  such  stimulations 
which  eventuates  in  a  discharge  which  the  patient  interprets 
as  pain. 

The  intensity  of  the  pain  is  determined  by  the  duration 
and  amount  of  the  stimulation  and  by  the  irritability  of  the 
nerve -fibers  and  ganglion -cells. 

The  expression  of  pain  is  no  measure  of  its  intensity. 
Animals  as  well  as  men  show  differences  in  their  sensitiveness 
to  pain.  A  frequent  clinical  error  is  to  underestimate  the 
intensity  of  pain  and  to  question  its  reality  simply  because 
by  diverting  the  attention  of  the  patient  the  latter  exhibits 
less  evidence  of  his  suffering. 

Pain  is  usually  worse  at  night  for  the  very  evident  reason 
that  in  the  daytime  our  attention  is  distracted. 

It  is  also  evident  that  the  imagination  of  pain  will  accen- 
tuate its  intensity.  In  estimating  pain  objectively  the  per- 
sonal equation  must  always  be  taken  into  consideration,  and 
by  aid  of  the  following  method45  one  may  determine  the 
degree  to  which  an  individual  is  sensitive  to  pain.  With 
the  thumb,  pressure  is  made  over  the  styloid  process  in  the 
neck.  Some  patients  will  complain  of  the  slightest  pressure, 
whereas  others  will  tolerate  considerable  pressure  without  a 
pain-reaction  (vide  vertebral  tenderness  on  page  71). 


55 


Spondylotherapy 


REFLEX    PAINS. 


As  a  rule  the  site  of  pain  corresponds  to  the  location  of 
the  lesion.  An  other  instances  peripheral  pains  may  be 
caused  by  diseases  of  the  spinal  cord.  Reflex  or  transferred 


FlG.  21. — Diagrams  showing  the  distribution  of  the  cerebro-spinal  strands  of 
nerves  and  the  location  of  transferred  pains  and  neuralgia. 

pains  may  be  caused  by  an  irritation  at  the  origin  of  the  nerve - 
trunk  and  the  pain  may  be  referred  to  its  peripheral  distribution. 

The  illustrations  of  Dana  (Fig.  21)  show  the  usual 
location  of  transferred  pains. 

Dana  observed  that  the  sensory  nerves  of  these  areas 

5b 


Sympathetic     Sensations 

were  correlated  with  the  sympathetic  ganglia  innervating  the 
areas  in  question. 

SYMPATHETIC  SENSATIONS. 

Quincke  has  collected  a  number  of  sympathefic  sensations 
associated  with  a  circumscribed  hyperalgesia  of  the  skin,  and 
one  is  constrained  to  conclude  that  the  skin-areas  are  sup- 
plied by  the  same  nerves  as  the  organs. 

According  to  Donaldson  the  splitting  nerve-fiber  sends 
one  portion  to  the  organ  and  one  to  the  skin  overlying  it. 

A  pertinent  illustration  of  cutaneous  hyperalgesia  is  ob- 
served in  affections  of  the  heart  when  pressure  of  the  skin 
over  the  heart -region  elicits  sensitiveness. 

As  a  rule  the  skin  overlying  an  organ  is  associated  with 
it  reflexly,  and  it  is  for  this  reason  that  one  can  explain  how 
percutaneous  therapeutic  methods  may  influence  visceral 
disease. 

SYMPATHETIC  SENSATIONS. 
AFFECTION.  SYMPATHETIC  SENSATIONS. 

Disease    of    the    middle-ear    and  Parietal  pains. 

mastoid  process. 

Disease  of  the  frontal  sinus.  Trigeminal  pains. 

Irritation  of  the  posterior  wall  of  Tendency  to   cough    (irradiation 

the  auditory  canal.  from  the  auricular  branch  of 

the  vagus). 

Pulmonary  abscess  (percussion  of) .  Pain  in  the  larynx. 

Angina  pectoris.  Pain  in  the  left  arm. 

Diseases  of  the  stomach.  Pain  in  the  back. 

Intestinal  worms.  Tickling  in  the  nose. 

Diseases  of  the  liver.  Pains  in  the  shoulder. 

Diseases  of  the  spleen.  Pains  in  the  left  shoulder. 

Diseases  of  the  bladder.  Pains  in  the  genitalia  and  lumbar 

region. 

Diseases  of  the  uterus.  Pain  in  the  epigastrium. 

Coxitis.  Pain  in  the  knee. 

57 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 


DERMATOMES  OF  HEAD. 

While  cutaneous  pains  are  usually  projected  with  great 
accuracy  to  the  point  stimulated,  pain  originating  in  the 
internal  organs  is  located  very  inaccurately. 

Head46  and  others  have  demonstrated  that  the  different 
visceral  organs  bear  a  definite  relation  to  certain  areas  of 
the  skin,  in  other  words,  in  visceral  disease,*  pain  and  dis- 
turbed sensation  may  be  referred  to  definite  cutaneous  areas. 
Thus  one  may  have  a  cutaneous  expression  of  visceral  disease 


FIG.    22. — Illustrating   cutaneous   tenderness   and   the   radiation   of   pain    in 
visceral  disease. 

which  I  may  call  an  endogenetic  skin  reflex.  The  cutaneous 
tenderness  in  visceral  disease  is  explained  as  follows :  When 
a  stimulus  is  applied  to  an  organ  or  tissue  with  diminished 
sensibility  and  which  is  centrally  connected  with  an  organ 
or  tissue  with  a  higher  degree  of  sensibility,  pain  is  referred 
to  the  organ  or  tissue  which  is  relatively  more  sensitive. 
Reference  to  Fig.  22  will  elucidate  this  matter. 

*Kast  and  Meltzer,15  found  in  animal  experimentation  that  the  sense  of  pain  is 
present  in  normal  organs,  and  that  it  is  considerably  augmented  in  inflamed 
organs,  and  that  a  subcutaneous  or  intramuscular  injection  of  cocain  is  capable 
of  completely  abolishing  the  sensation  in  normal  as  well  as  in  inflamed  organs. 
They  suggest  that  the  anesthesia  of  the  abdominal  organs  observed  by  some 
surgeons  was  due  to  the  use  of  cocain. 

58 


D 


m        a       t       o       m 


If  the  viscus  is  irritated,  say  as  the  result  of  inflammation, 
sensory  impulses  which  are  usually  below  the  threshold  of 
consciousness  are  conveyed  to  its  sensory  center  or  segment 
in  the  spinal  cord.  Now  to  the  same  segment  is  also  con- 
nected a  definite  area  of  skin  from  which  sensory  impressions 
are  habitually  received,  hence  the  sensations  in  consciousness 
are  not  referred  to  their  true  visceral  origin  but  to  the  surface 
of  the  body. 

Now  Head  found  that  in  many  visceral  diseases,  if  the 
sensitiveness  of  the  skin  were  tested  by  running  a  pin  point 
over  the  cutaneous  surface,  definite  areas  could  be  demon- 
strated showing  hypersensitiveness  (hyperalgesia)  to  pain. 
Such  areas  on  the  surface  of  the  body  are  known  as  skin- 
units  or  dermatomes.  The  latter  correspond  to  the  spinal 
segments,  from  which  the  posterior  roots  take  their  origin  and 
not  to  their  peripheral  distribution. 

The  dermatomes  are  hypersensitive  to  heat  and  cold,  but 
not  to  touch.  Head  concluded  that  when  the  dermatomes 
could  be  demonstrated  they  invariably  indicated  an  affection 
of  the  organ  to  which  they  corresponded.  The  dermatomes 
or  zones  of  hyperalgesia  appear  early  and  continue  through- 
out the  course  of  a  visceral  disease.  If  absent,  say  in  ap- 
pendicitis, they  appear  after  palpation  of  the  appendix.  The 
author  has  found  that  if  the  zones  are  present  they  are 
practically  always  exaggerated  after  manipulation  of  a  given 
organ. 

As  a  rule  the  disappearance  of  a  zone  is  associated  with 
relief  of  a  diseased  organ.  If,  however,  the  symptoms  in- 
crease or  persist,  the  sudden  disappearance  of  a  zone  is  a 
sign  of  ill-omen.45 

There  is  no  definite  relation  between  the  severity  of  the 
visceral  lesion  and  the  degree  of  cutaneous  hyperalgesia. 
The  absence  of  a  zone  does  not  exclude  a  lesion  of  a  given 

59 


Spondylotherapy 

organ,  but,  if  demonstrated,  it  is  corroborative  evidence  that 
such  a  lesion  is  present. 

It  is  important  to  remember  that  counterirritation  over  a 
zone  of  hyperalgesia  is  often  surprisingly  efficient  in  relieving 
the  pain  and  underlying  condition  of  the  visceral  disease. 

The  application  of  cold  to  the  abdomen  in  acute  abdom- 
inal affections  owing  to  the  anesthesia  produced  is  equally 
efficient. 

On  the  same  theory  Elsberg  and  Neuhof,45  secure  relief 
from  pain  in  acute  affections  by  anesthetizing  the  hyperalg- 
esic  area  with  menthol  (50  per  cent). 

Reference  to  Figs.  23,  24,  25  and  26  shows,  according  to 
Head  and  Schmidt,47  the  segmental  distribution  of  referred 
pain  and  cutaneous  tenderness  in  visceral  disease,  and  Fig.  27 
shows  the  associated  painful  areas  about  the  head  related 
to  visceral  disease  and  areas  of  referred  pain  and  tenderness 
in  affections  of  the  head  and  neck. 

METHODS  FOR  ELICITING  THE  DERMATOMES. 

Head  tested  the  skin  sensitiveness  to  pain  by  pinching 
up  folds  of  skin  or  by  stroking  the  skin  with  the  point  of  a 
sharp  pin. 

I  often  employ  the  vibrations  of  a  tuning-fork  for  demon- 
strating the  zones  and  the  vibration -sensation  may  either  be 
increased  (hyperalgesia)  or  diminished  (hypalgesia). 

The  method  of  Elsberg  and  Neuhof45  is  as  follows:  A 
sharp  pin  is  held  between  the  thumb  and  index  finger  of  the 
the  right  hand,  the  nail  of  the  index  finger  resting  on  the 
patient's  skin.  The  pin  is  then  made  to  traverse  slowly  the 
surface  of  the  skin,  care  being  taken  that  the  nail  of  the  index 
finger  presses  equally  along  the  area  examined.  The  patient 
must  say  "now"  the  moment  the  stroke  of  the  pin  becomes 
painful. 

60 


Dermatomes 


I-'IGS.  23  and  24. — Sensory  areas  of  the  skin  according  to  Head.  Anterior  and 
posterior  views.  C,  cervical;  D,  dorsal;  L,  lumbar  segments  of  the  cord.  Further 
description  of  these  and  subsequent  figures  on  page  62. 

* 
61 


S  p    o     n    d    y    I    o     t    h     e    r    a    p    y 


SEGMENTAL  DISTRIBUTION  OF  REFERRED  PAIN  AND  TENDER- 
NESS IN  VISCERAL  DISEASE. 

SEE  FIGS.  23,  24,  25  AND  26. 

Heart. — Third  cervical  and  first,  second  and  third  dorsal  segments. 

Lungs. — Third  and  fourth  cervical  and  first  to  ninth  (sometimes  tenth)  dorsal 
segments,  especially  the  third,  fourth  and  fifth. 

Breast. — Fourth  and  fifth  dorsal  segments. 
Esophagus. — Fifth,  sixth  and  eighth  dorsal  segments. 

Stomach. — Third  and  fourth  cervical  and  sixth,  seventh,  eighth  and  ninth 
dorsal  segments.  Cardiac  end  from  the  sixth  and  seventh  and  the  pyloric  end 
from  the  ninth. 

Intestines. — Down  to  the  upper  part  of  the  rectum:  Ninth,  tenth,  eleventh 
and  twelfth  dorsal  segments.  Rectum:  Second,  third  and  fourth  sacral  segments. 

Liver  and  Gall-bladder. — Seventh,  eighth,  ninth  and  tenth  dorsal  segments 
and  perhaps  the  sixth. 

Kidney  and  Ureter. — Tenth,  eleventh  and  twelfth  dorsal  segments.  The 
nearer  the  lesion  lies  to  the  kidney  the  more  is  the  pain  and  tenderness  associated 
with  the  tenth  dorsal  segment.  The  lower  the  lesion  in  the  ureter  the  more  does 
the  first  'umbar  segment  tend  to  appear. 

Biadaet. — Mucous  membrane  and  neck  of  the  bladder:  First,  second,  third 
and  fourth  sacral  segments.  Over-distention  and  ineffectual  contraction:  Eleventh 
and  twelfth  dorsal  and  first  'umbar  segments. 

Prostate. — Tenth,  eleventh  anc1  twelfth  dorsal,  first,  second  and  third  sacral 
and  third  lumbar  segments 

Epidiaymis. — Eleventh  ana  twelfth  dorse    ?nd  first  lumbar  segments. 

Testis  — Tenth  dorsal  segment. 

Ovary. — Tenth  dorsal  segment. 

Uterine  Appendages. — Eleventh  and  twelfth  dorsal  and  first  mmbar  segments. 

Uterus. — In  contraction:  Tenth,  eleventh  and  twelfth  dorsa!  and  first  iumbar 
segments.  Os  uteri:  First,  second,  third  and  fourth  sacral  segments,  and  very 
rarely,  the  fifth  lumbar 


62 


Dermatomes 


Flos  25  and  26- — Sensory  areas  of  the  skin  according  to  Head. 


Spondyloth     e    r    a    p    y 


ASSOCIATED    PAINFUL   AREAS   ABOUT   THE  HEAD  RELATED  TO 
VISCERAL  DISEASE. 

SEE  FIG.  27. 


AREA  ON  BODY. 

ASSOCIATED  AREA 
ON  HEAD. 

ORGANS  IN  PARTICULAR  RELATION 
WITH  THESE  AREAS. 

Cervical  3  and  4 

Fronto-nasal 

Apices   of   lungs,    stomach,    liver, 

aortic  orifice  (?). 

Dorsal  2  and  3 

Mid-orbital 

Lung,  heart,  arch  of  the  aorta. 

Dorsal  4 

Doubtful 

Lung. 

Dorsal  5 

Fronto-temporal 

Lung  and  occasionally  the  heart. 

Dorsal  6 

Fronto-temporal 

Lower  lobe  of  lung  and  heart. 

Dorsal  7 

Temporal 

Bases  of  lungs,  heart  and  stomach. 

Dorsal  8 

Vertical 

Stomach,  liver  and  upper  part  of 

the  small  intestine. 

Dorsal  9 

Parietal 

Stomach  and  upper  part   of  the 

small  intestine. 

Dorsal  10 

Occipital 

Liver,  intestine,  ovary  and  testicle. 

AREAS  OF  REFERRED  PAIN  AND  TENDERNESS  IN  AFFECTIONS  OF 
THE  HEAD  AND  NECK. 

SEE  FIG.  27. 


ORGAN    INVOLVED. 

MAXIMUM   POINT 
OF  REFERRED  PAIN 
AND  TENDERNESS. 

ORGAN    INVOLVED. 

MAXIMUM  POINT  OF 
REFERRED   PAIN 
AND  TENDERNESS. 

Ciliary  muscle 

Mid-orbital 

Upper  teeth 

Frontonasal,  nasolabial, 

(Disorders  of 

temporal,     maxillary, 

accommodation) 

or  mandibular. 

Cornea 

Frontonasal 

Lower  teeth 

Mental,  hyoid,  superior 

laryngeal  and  in  the 

ear. 

Iris 

Fronto  -  temporal, 

Tongue,     anterior 

Mental. 

temporal,  and 

part 

maxillary 

Vitreous  body 

Temporal 

Tongue,  lateral 

Hyoid,    superior    laryn- 

(Glaucoma) 

part 

geal  and  in  the  ear. 

Retina 

Vertical 

Tongue,  posterior 

Superior  laryngeal,   hy- 

part 

oid,  occipital. 

Tympanic  mem- 

Hyoid 

Tonsil 

Hyoid  and  in  the  ear. 

brane 

Middle  ear 

Vertical    and    be- 

Nose,   olfactory 

Frontonasal    and    mid- 

hind  the  ear 

portion 

orbital. 

Nose,    respiratory 

Nasolabial  (occasion- 

portion  and  pos- 

ally). 

terior  nares 

Larynx 

Superior    and     inferior 

laryngeal  (in  destruc- 

tive lesions). 

64 


a 


n     f     u      I       A 


a 


65 


S  p    o    n    d    y    I    o    the    r    a    p    y 

Not  infrequently,  if  the  hyperalgesia  is  pronounced,  the 
patient  will  scream  as  soon  as  the  border  of  the  zone  is 
reached.  Young  children  cannot  give  correct  answers, 
hence  with  them  this  method  is  useless.  The  zones  of 
hyperalgesia  extend  from  the  median  line  in  front  to  the  spines 
behind. 

In  Figs.  28  and  29  (Elsberg  and  Neuhof ),  the  maximum 
areas  of  sensitiveness  within  the  boundaries  of  a  zone  are 
deeply  shaded. 

VERTEBRAL  PAIN. 

This  symptom  may  be  determined  in  a  variety  of  ways : 

1.  By  pressure  of  the  vertebral  spines  with  the  fingers 
or  by  percussion  of  the  spines  by  means  of  the  plexor  and 
pleximeter  (Fig.  2).       The  latter  method  is  preferable.  Very 
frequently  no  pain  is  elicited  when  a  vertebral  spine   is 
pressed  downward,  yet,  when  the  spine  is  pushed  to  one  side 
or  lifted,  sensitiveness  can  be  demonstrated. 

2.  By  pressure  alongside  of  the  spine  at  points  corre- 
sponding to  the  exit  of  the  spinal  nerves. 

3.  By  pressure  vertically  down  through  the  spine  made 
on  the  head  and  again  on  the  shoulders. 

4.  By  firm  pressure  on  the  transverse  processes  so  as  to 
rotate  the  individual  vertebrae  and  thus  determine  implication 
of  the  joints. 

5.  By  aid  of  the  hot-sponge  test ,  which  consists  of  passing 
down  the  spine  a  sponge  wrung  out  in  warm  water.     The 
latter  must  only  be  sufficiently  warm  so  as  not  to  be  unpleas- 
ant to  the  healthy  skin.     In  definite  affections,  notably  my- 
elitis, pain  is  experienced  by  the  patient  when  the  sponge 
passes  over  the  site  of  the  disease. 

6.  By  testing  pain-susceptibility  (pallesthesia).    In  the 
norm,  if  a  C   (130  vibrations)  or  an  A   (440  vibrations) 

66 


a 


I 


a 


n 


tuning-fork  is  placed  on  any  of  the  vertebral  spines,  a  trem- 
bling or  whizzing  sensation  is  perceived.  The  skin,  as  well 
as  the  bone,  participates  in  the  perception  of  the  vibrations. 
Sensation  is  diminished  or  lost  (bone -anesthesia)  in  the 
ataxic  stage  of  tabes.  Bone-sensibility  may  be  increased  in 


FlG.  28. — General  location  and  outline  of  hyperalgesic  zones  for  some  of  the 
abdominal  organs.  Anterior  view.  The  maxima  are  deeply  shaded. 

incipient  tabes  and  the  vibrations  of  the  fork  produce  a 
burning  as  well  as  the  whizzing  sensation. 

Bone-sensibility  is  also  altered  in  other  nervous  affections, 
thus  in  hysteria,  the  application  of  the  fork  is  followed  by 
the  sudden  disappearance  of  sensibility  of  the  bone  and 
skin. 

If  the  vertebrae  or  corresponding  spinal  nerve-roots  are 

67 


Spondyloth 


r    a    p    y 


sensitive,  the  vibrations  of  the  tuning-fork  are  more  keenly 
appreciated  by  the  patient. 

7.  By  finding  painful  centers.40  For  this  purpose  the 
patient's  back  is  bared  and  a  high  tension  Faradic  coil  is 
brought  into  use.  Before  applying  this  current  the  coil 


FlG.  29. — Posterior  view  of  the  zones  in  Fig.  28. 

should  be  tested  with  a  four-to-six  inch  Geissler  tube.  If 
the  coil  is  capable  of  illuminating  the  tube,  then  it  possesses 
the  proper  amount  of  penetrative  power.  For  this  diagnostic 
work  the  Kidder  Manufacturing  Company  of  New  York 
make  a  special  coil.  One  pole  of  the  battery  (it  does  not 
make  any  difference  which)  is  attached  to  the  6x6  inch 
moist  electrode  and  placed  in  front  over  the  epigastric  plexus. 
The  other  electrode  (2x2  inches),  well  moistened,  is  passed 

68 


Vertebral        Pain 

lightly  over  the  spinal  column  with  a  current-strength 
sufficient  to  be  agreeably  susceptible.  This  current  is  passed 
up  and  down  the  entire  length  of  the  spinal  column  with 
ordinary  pressure  eight  or  ten  times  and  the  electrodes  re- 
moved when  one  will  note  vivid  red  spots  on  a  white  back- 
ground. The  latter  become  more  prominent  several  min- 
utes after  the  current  is  removed.  Digital  pressure  upon 
these  spots  will  elicit  sensitiveness,  whereas  no  pain  will  be 
complained  of  in  the  intermediate  region. 

These  spots  are  pathognomonic  of  certain  ailments  and 
the  clinician  can  almost  make  a  diagnosis  from  the  reflex 
centers  involved. 

8.  Very  frequently,  if  one  pole  of  a  Galvanic  current 
(with  the  other  electrode  at  an  indifferent  point)  is  passed 
along  the  spine,  no  appreciable  sensation  is  felt  until  a  sen- 
sitive area  is  attained. 

9.  It  is  known  that  many  patients  suffer  from  pains  in 
the  head  and  chest  when  exposed  to  draughts.     The  latter 
may  be  substituted  by  a  current  of  cold  air  from  an  air- 
pump,  which,  when  directed  at  the  vertebral  exits  of  the 
affected  nerves,  will  reproduce  the  pains  from  which  the 
patient  suffers.    Very  often  the  pain  is  also  reproduced  when 
the  air  is  directed  on  the  site  of  the  reflected  pains. 

Other  methods  for  the  elicitation  of  vertebral  tenderness 
are  described  on  page  72. 

Having  located  by  any  of  the  foregoing  methods  the  area 
of  tenderness,  it  is  well  to  employ  some  mark  for  future  refer- 
ence in  treatment.  For  this  purpose  a  stick  of  nitrate  of 
silver,  slightly  moistened,  may  be  used  as  a  pencil,  thus 
leaving  a  line  which  cannot  be  effaced.  If  one  desires  to 
remove  the  stain  of  the  latter,  apply  a  drop  of  tincture  of 
iodine  and  then  ammonia,  or  use  potassium  iodid  solution. 


69 


S    p     o     n    d    y    I    o    therapy 


DEDUCTIONS  RESPECTING  VERTEBRAL  PAIN. 

For  the  objective  elicitation  of  pain,  one  must  exclude 
cutaneous  hyperesthesia,  which  is  a  dominant  factor  in  the  so- 
called  hysterical  spine  and  which  is  present  in  many  neuroses. 
Here,  when  the  skin  is  lightly  touched  or  pinched  without 
any  pressure  on  the  bone,  pain  is  experienced.  If  the 
patient's  attention  is  diverted  the  identical  spot  may  be 
touched  without  eliciting  any  pain.  Friction  of  the  tender 
area  with  a  rough  fabric  of  cotton  to  induce  irritation  of  the 
skin  is  often  followed  by  disappearance  of  the  painful  areas. 

Tenderness  of  the  vertebrae,  rather  than  pain,  is  rarely 
absent  in  neurasthenia  and  sensitive  areas  may  be  demon- 
strated in  the  latter  affection  as  well  as  in  hysteria. 

These  TOPOALGIAS  may  not  disappear  until  treatment  is 
directed  to  the  general  condition. 

Topoalgia  limited  to  the  vertebral  column  is  known  as 
rachialgia.  In  the  hysterical  spine  there  is  usually  a  history 
of  traumatism  and  it  must  be  recalled  that  hysteria  long 
latent  and  unrecognized  may  be  awakened  into  obvious 
activity  by  a  blow  or  accident. 

To  determine  whether  a  given  sensitive  area  is  real  or 
simulated,  the  following  signs  may  be  employed : 

1.  Mannkopff's  sign. — Take  the  pulse-rate  before,  dur- 
ing, and  after  pressure  is  made  on  the  sensitive  area.     If  the 
pulse  becomes  increased  in  frequency  it  is  a  proof  that  the 
pain  is  genuine. 

2.  Sign  of  Lcewi. — Dilatation  of  the  pupil  is  in  direct 
proportion  to  the  intensity  of  the  pain.     Thus,  if  in  a  healthy 
man  one  exercises  energetic  pressure  on  the  testicle,  the  pupil 
dilates,  whereas  in  the  tabetic  in  whom  the  testicle  is  in- 
sensitive, no  pupillary  dilatation  is  observable. 

70 


Vertebral     Tenderness 

3.  In  neuroses  the  spine  is  not  rigid  at  the  points  of 
sensitiveness. 

In  diagnosis  one  must  look  for  other  symptoms  suggestive 
of  a  neurosis. 

In  children  radiating  pains  dependent  on  vertebral  disease 
are  frequently  misinterpreted,  as  headache,  cough  or  stom- 
achache. 

In  Pott's  disease  reflex  muscular  spasm  is  associated  with 
pain.  In  disease  of  the  cervical  region  the  head  is  held 
stiffly  or  is  supported  with  the  hands. 

In  disease  of  the  dorsal  region  the  pain  may  radiate  to 
the  chest,  respiration  may  be  groaning  and  night  cries  occur. 

In  lumbar  disease  the  pain  is  referred  to  the  legs  or  lower 
abdominal  region.  In  Pott's  disease  there  may  be  absolutely 
no  local  pain  on  pressure,  but  spasm  of  the  spinal  muscles, 
especially  on  an  attempted  movement,  is  practically  always 
present  and  is  an  early  sign. 

Angular  deformity  of  the  spine  is  a  late  manifestation 
of  the  disease. 

Pains  due  to  other  causes  are  discussed  later. 

VERTEBRAL  TENDERNESS. 

The  elicitation  of  the  dermatomes  of  Head  is  a  tedious 
method  of  examination  and  not  always  accompanied  by 
satisfactory  results  for  the  reason  that  a  great  amount  of 
experience  is  necessary.  Alsberg18  in  the  examination  of  200 
women  (with  gynecological  affections)  found  cutaneous 
areas  of  hyperalgesia  in  only  seventeen,  ten  of  whom  were 
hysterical.  Therefore,  he  could  attribute  no  diagnostic  im- 
port to  the  zones  in  question  beyond  commenting  on  the  fact 
that  hysterical  stigmata  must  be  excluded  before  the  zones 
of  hyperalgesia  could  be  regarded  as  trustworthy. 

There  is  no  longer  any  doubt  concerning  the  fact  that 

71 


S  p    o     n    d    y    I    o     t    h     e    r    a    p    y 

spinal  tenderness  corresponding  to  different  segments  of  the 
spinal  cord  is  associated  with  visceral  disease.  To  attain 
definitiveness  of  localization,  however,  it  is  necessary  to  care- 
fully examine  the  vertebrae  by  percussion  (page  66),  or  by 
palpation ;  place  the  patient  in  the  recumbent  position,  first 
on  the  right  and  then  on  the  left  side,  to  secure  muscular 
relaxation,  for  it  is  quite  evident  that  a  contracted  muscle 
over  a  given  area  of  sensitivenes's  will  thwart  the  elicitation 
of  pain. 

If  the  patient  is  seated  the  muscles  may  be  relaxed  by 
having  the  patient  lean  backward. 

Pressure  with  the  finger  (care  must  be  taken  that  the 
pressure  is  equal)  is  next  made  over  each  intervertebral 
foramen  and,  if  contracted  muscular  bundles  or  pain  can  be 
demonstrated  by  the  palpating  finger,  vertebral  tenderness 
is  present. 

The  writer  has  frequently  found  that,  firm  pressure  on  the 
sensitive  vertebras  may  evoke  pain  in  lieu  of  tenderness  and 
what  is  of  greater  diagnostic  import  is  the  fact  that,  some 
of  the  sensations  from  which  a  patient  suffers  may  be 
reproduced. 

Many  recent  writers,  notably  Arnold17  and  Ludlum18, 
found  that  the  areas  of  vertebral  tenderness  correspond  to  the 
vaso-motor  centers  in  the  spinal  cord  and  that  there  exists  a 
compensatory  relationship  between  the  blood-vessels  of  the 
cord  and  those  structures  supplied  by  the  posterior  primary 
divisions  of  the  spinal  nerves. 

The  vaso-motor  nerves  are  evidently  not  wholly  concerned 
in  vertebral  tenderness.  Physiology  teaches  that  our  con- 
scious sensations  do  not  originate  in  the  viscera  to  which 
the  afferent  nerves  are  distributed  and  where  they  are  stimu- 
lated. On  the  contrary,  the  nerves  merely  transmit  the 
stimuli  to  the  gray  matter  of  the  spinal  cord  (section  of  which 

72 


Vertebral     Tend 


e   r  n   e  s  s 


abolishes  sensations  of  pain  without  affecting  the  tactile 
sensations),  whereby  through  summation  they  produce 
changes  in  the  cells  of  the  gray  matter.  Such  changes  are 
identified  with  hyperesthesia  and  hence  the  vertebral 
tenderness. 

It  is  known  that  frequently  repeated  painless  tactile 
stimuli  may  eventually  arouse  the  sensation  of  pain. 

Again,  a  neuritis  at  first  limited  to  a  visceral  nerve  may 
pass  upwards  (ascending  neuritis)  and  involve  larger  nerve- 
trunks  or  even  the  spinal  cord.  It  is  in  this  way  only  that 
one  can  explain  the  vertebral  tenderness  which  persists  after 
apparent  recovery  from  a  visceral  disease. 

In  addition  to  the  vaso-motor  and  sensory  reflex  phenom- 
ena in  visceral  disease  there  are  also  motor  symptoms.  The 
latter  may  be  experienced  by  either  an  irritation  or  paresis. 
Thus,  in  angina  pectoris,  the  constriction  around  the  chest 
is  dependent  upon  a  contraction  of  the  intercostal  muscles. 
Paretic  symptoms  may  attend  a  paroxysm  and  enfeebled 
power  of  the  muscles  of  the  left  arm  is  present.  In  the  inter- 
paroxysmal 'periods  of  angina,  as  well  as  in  other  cardiac 
lesions,  sensory,  motor  and  vaso-motor  symptoms  may  be 
demonstrated  in  several  segments  of  the  spinal  cord,  and 
Mackenzie's  conception  of  them  is  as  follows:  In  cardiac 
disease  (as  a  paradigm)  a  persistent  irritation  of  the  sym- 
pathetic nerve  conduces  to  the  irritation  of  the  spinal  seg- 
ment at  a  site  where  the  fibers  of  the  heart  connect  with  the 
spinal  cord.  Irritation  of  the  sensory  part  of  the  spine  con- 
duces to  the  sensation  which  is  projected  into  the  periphery 
innervated  by  the  nerves  of  the  spinal  segment  (law  of 
Muller).  After  this  manner  the  motor  and  vaso-motor 
symptoms  are  of  like  segmental  character.  The  following 
table  fairly  represents  the  areas  of  vertebral  tenderness  in 
visceral  disease  and  corresponds  to  the  distribution  of  the 
spinal  segments. 


S  p 


o    n 


d 


I 


t    h 


r    a   p    y 


VERTEBRAL   TENDERNESS   IN   VISCERAL   DISEASE. 


VISCERAL  DISEASE.* 
GASTRIC  ULCER. 

CHOLELITHIASIS  (Gall-stones). 

CARDIAC  DISEASES. 
PULMONARY  DISEASES. 
GASTRIC  DISEASES. 
PELVIC  DISEASES. 


VERTEBRAL  TENDERNESS. 

At  the  level  of  and  to  the  left  of 
the  loth  to  the  i2th  dorsal 
vertebra. 

Somewhat  to  the  right  of  the  i2th 
dorsal  vertebra.  Painful  area 
may  persist  for  weeks  after  an 
attack. 

Usually  to  the  left  of  the  first  four 
dorsal  vertebrae. 

From  the  3d  to  the  6th  dorsal 
vertebra. 

From  the  4th  to  the  xoth  dorsal 
vertebra. 

At  the  4th  and  5th  lumbar  verte- 
bras. 


The  foregoing  table  is  based  on  the  observations  of 
different  writers  on  the  subject  and  the  author  presents  the 
following  table  of  vertebral  tenderness  in  visceral  disease, 
which  he  has  elaborated  after  palpation  of  the  palpable 
organs  and  by  aid  of  his  visceral  reflexes  (Fig.  30).  Thus, 
in  myocarditis,  the  symptoms  of  this  affection  may  be  elicited 
by  concussion  of  the  four  lower  dorsal  vertebrae  (Fig.  5), 
which  manceuver  provokes  dilatation  of  the  heart.  If  the 
counter-reflex  of  cardiac  contraction  is  provoked  by  concus- 
sion of  the  yth  cervical  vertebra,  the  area  of  vertebral  tender- 
ness disappears  at  once. 

One  may  also  note  that  the  vertebral  tenderness  after 
palpation  of  an  organ  is  of  a  few  minutes  duration  only,  and 


*Vide  also  the  observations  of  the  Griffin  brothers  (page  2). 

74 


V  e  r  t  e  b 


r  a 


I    T 


e  n 


d 


e  r  n  e  s  s 


if  present  before  manipulation  of  the  diseased  viscus  it  is 
accentuated  after  such  manipulation.  The  point  of  tender- 
ness is  located  either  at  the  side  of  the  vertebrae  or  at  a  point 
4  cm.  from  the  median  line  of  the  spinous  processes  or  in 
both  situations.  It  is  better  to  determine  vertebral  tender- 
ness before  palpating  the  organs,  for  otherwise  one  is  unable 


LffT  St*0£ 


Sfpf 


FIG.  30. — Vertebral  areas  of  tenderness  after  palpation  of  the  viscera.  The 
localization  is  only  approximate. 

to  say  whether  the  tenderness  in  question  was  not  already 
present. 

A  practical  point  in  relation  to  these  areas  of  vertebral 
tenderness  after  palpating  a  sensitive  organ,  joint  or  tissue 
is  the  following  fact :  If  the  area  of  vertebral  tenderness  is 
thoroughly  frozen,  the  organ,  joint  or  tissue  may  be  manipu- 
lated for  a  time  with  either  diminished  or  no  pain.  Even  the 
subjective  pain  may  disappear  for  hours  after  the  freezing. 

75 


Spondylotherapy 

If  the  sensibility  of  the  skin  over  the  painful  organ,  tissue 
or  joint  is  tested  with  a  pin  before  and  after  freezing,  it  will 
be  noted  after  the  latter  manoeuver  that  the  skin  is  anesthetic. 
This  anesthesia  is  likewise  of  variable  duration.  The  cita- 
tion of  two  observations  will  make  my  meaning  more  lucid. 

I.  The  subject  has  gout  located  in  the  left  metatarso- 
phalangeal  articulation  of  the  big  toe.    The  latter  is  ex- 
quisitively  tender  on  manipulation.     There  are  no  vertebral 
points  of  tenderness.     The  toe  is  now  manipulated  and  when- 
ever it  is  moved  a  localized  muscular  spasm  may  be  palpated 
at  the  side  of  the  spine  of  the  nth  dorsal  vertebra.    Within 
a  minute  two  points  of  vertebral  tenderness  may  be  located 
corresponding  to  the  left  side  of  the  nth  dorsal  vertebra  and 
another  about  4  cm.  to  the  left  of  the  spinous  process  of  the 
latter  vertebra. 

The  vertebral  areas  of  tenderness  are  now  thoroughly 
frozen  and  within  two  minutes  the  big  toe  may  be  manipu- 
lated without  pain.  The  skin  over  the  toe  in  question  is 
anesthetic.  The  anesthesia  lasts  only  three  minutes,  but  the 
patient  is  without  pain  in  the  joint  until  the  following  day. 
Again  the  vertebral  area  (which  has  been  marked  with  a 
stick  of  silver  nitrate  to  avoid  a  repetition  of  localization)  is 
frozen  and  the  patient  is  without  pain  for  two  days.  Two 
more  freezings  sufficed  to  control  the  pain  completely. 

II.  The  subject  has  an  ulcer  of  the  stomach.    A  sensi- 
tive vertebral  point  is  already  present,  but  when  the  tender 
point  over  the  stomach  is  subjected  to  pressure,  the  vertebral 
area  becomes  decidedly  more  sensitive.     The  latter  area  is 
now  frozen,  after  which  procedure  the  sensitive  point  over 
the  stomach  may  be  manipulated  with  scarcely  any  pain  at 
-all.     The  subjective  pains  of  the  patient  disappeared  for 
only  six  hours.     Freezing  was  again  executed  and  the  pains 
evanesced  for  twelve  hours. 

76 


Vertebral     Tenderness 

Now  to  the  average  physician  it  would  be  ridiculous  to 
assume  that  freezing  over  the  area  of  vertebral  tenderness  was 
anything  more  than  a  palliative  measure,  yet  sober  thought 
endows  analgesia  with  curative  action. 

The  use  of  anesthetics  to  wounds  will  hasten  their  healing 
and  by  so  doing  we  are  executing  what  the  author  is  pleased 
to  call  a  "peripheral  rest-cure."  Rest  of  any  kind  in  the 
treatment  of  painful  organs  or  tissues  is  curative. 

The  author  has  seen  abraded  surfaces  on  the  lips  and 
mucous  membranes,  which  having  resisted  treatment  for 
months  were  regarded  as  clinically  malignant.  These 
abraded  surfaces  were  constantly  irritated  by  cauterization 
and  the  use  of  antiseptic  lotions,  yet  in  a  few  days  a  pro- 
tective coating  of  collodion  over  the  abraded  surfaces  sufficed 
to  cure  them. 

One  must  also  remember  that  the  nerves  which  convey 
sensory  impressions  also  carry  trophic  fibers. 

Take  again  coughs.  When  the  sinusoidal  current  is  used 
with  one  electrode  over  the  sacrum  and  the  other  applied 
alternately  over  the  spinous  processes,  it  will  be  found  that  a 
reflex  cough  can  be  excited  in  many  instances  over  the 
spinous  processes  of  the  6th,  yth,  8th  and  gth  dorsal  vertebrae. 
Patients  with  persistent  coughs  will  often  show  areas  of 
vertebral  tenderness  corresponding  to  the  vertebrae  in 
question.  If  now,  the  tender  areas  are  thoroughly  frozen, 
it  is  an  excellent  means  of  inhibiting  a  cough.  Inhibition  of 
a  cough  is,  in  many  instances,  a  curative  measure  and  when 
we  employ  narcotics  with  discretion  to  subdue  a  persistent 
cough  in  bronchitis  and  other  pulmonary  affections  recovery 
is  hastened.  Concerning  the  action  of  freezing  for  the  relief 
of  pain,  vide  page  172. 

The  author  has  also  noted  that  areas  of  vertebral  tenderness 
may  be  elicited  when  definite  areas  of  the  skin  are  irritated 

77 


S    p     ondylotherapy 


by  pinching  or  by  means  of  a  point  of  a  pin.  Such  areas  of 
tenderness  are  likewise  of  short  duration  and  appear  on  the 
same  side  of  the  vertebral  column  (or  4  cm.  from  the  spinous 
processes)  corresponding  to  the  side  of  cutaneous  irritation. 
The  areas  of  tenderness  may  not  appear  for  fully  a  minute 
after  scratching  or  pinching  a  definite  cutaneous  area. 


GO—' 

Ga 


FIG.  31. — Approximate  areas  of  vertebral  tenderness  elicited  after  irritation 
of  cutaneous  areas  in  different  regions. 

Localized  spasm  of  the  spinal  musculature  is  associated 
with  the  tenderness,  i.  e.,  each  time  the  skin  is  irritated  the 
finger  detects  a  muscular  contraction  corresponding  to  the 
area  where  tenderness  will  subsequently  appear.  By  this 
means  one  is  now  in  the  possession  of  an  objective  method 
for  determining  pain-reaction  to  cutaneous  stimulation.  The 
intensity  of  pain  is  an  individual  question  and  depends  as 
much  on  the  sensitiveness  of  the  registering  apparatus  as  it 
does  on  the  degree  of  stimulation. 

78 


Vertebral     Percussion 

The  localization  of  vertebral  tenderness  in  the  writer's 
experience  cannot  be  governed  by  any  fixed  rules,  the  individ- 
ual case  only  must  serve  as  a  criterion. 

The  various  therapeutic  methods  discussed  in  a  sub- 
sequent chapter  (chapter  V),  when  applied  to  the  areas  of 
tenderness  are  endowed  with  considerable  value  in  influencing 
the  visceral  condition.  This  statement  applies  with  special 
cogency  to  the  vaso-motor  and  viscero-motor  fibers  from  a 
given  segment. 

INTERCOSTAL  NEURALGIA  is  a  frequent  condition  respon- 
sible for  vertebral  tenderness  and  is  discussed  at  length  on 
page  1 86. 

VERTEBRAL  PERCUSSION. 

The  tracheo -bronchial  glands  are  enlarged  in  pertussis 
and  in  other  infectious  diseases,  notably  in  children. 

In  every  one  of  127  cases  of  tuberculosis,  Northrup  found 
the  glands  enlarged. 

BRONCHIAL  PHTHISIS  has  been  fully  described  in  the 
literature  but  the  scope  of  such  description  has  been  limited 
in  regarding  it  as  an  affection  peculiar  to  children  with  symp- 
toms suggestive  of  increased  intrathoracic  pressure. 

The  author  has  portrayed19  a  picture  of  bronchial 
phthisis  occurring  in  adults  which  in  all  essentials  tallies  with 
the  tableau  of  symptoms  common  to  pulmonary  tuberculosis 
with  which  it  is  frequently  confounded.  In  an  analysis  by 
the  author  of  100  cases  of  bronchial  phthisis  the  following 
diagnostic  conclusions  were  formulated : 

1.  There  is  a  history  of  cough  which  is  spasmodic  in 
character  and  almost  suggests  the  brazen,  metallic  cough 
of  aortic  aneurism. 

2.  Tubercle  bacilli  may  be  found  in  the  sputum  after 
repeated  examinations,  and  then  only  when  the  bronchial 
glands  have  suppurated  and  perforated  the  bronchus,  or 
when  tuberculosis  is  present  elsewhere  in  the  lungs. 


Spondylotherapy 

3.  Dyspnea  is  out  of  all  proportion  to  the  signs  obtained 
by  physical  examination  of  the  lungs. 

4.  Dullness    of    the    lungs  anteriorly  and  posteriorly, 
corresponding  to  the  bifurcation  of  the  trachea  (at  about  the 
level  of  the  intervertebral  disc  between  the  4th  and  5th  dorsal 
vertebrae). 

5.  The  Smith  and  Hare  sign,  viz.,  when  the  patient 
throws  the  head  well  back  a  "purring"  sound  is  heard  when 
the  stethoscope  is  placed  below  the  suprasternal  notch. 

6.  The  Roentgen  ray  evidence  (enlarged  glands),  viz., 
when  the  target  of  the  tube  is  so  placed  that  when  the  rays 
are  traversing  the  chest,  they  will  fall  at  a  point  corresponding 
to  either  the  right  or  the  left  side  of  the  vertebral  column 
posteriorly  corresponding  to  a  point  just  below  the  bifurcation 
of  the  trachea. 

Among  the  signs  cited  dullness  over  the  manubrium  sterni 
anteriorly  and  posteriorly  corresponding  to  the  4th,  5th  and 
6th  dorsal  vertebrae  is  common. 

It  must  be  recalled,  however,  that  the  region  correspond- 
ing to  the  5th  dorsal  vertebra  is  normally  dull,  the  dullness 
extending  for  a  short  distance  on  either  side  of  the  vertebral 
column  but  more  to  the  right  than  to  the  left  side.  The 
shape  and  size  of  this  square  patch  of  dullness,  if  much 
modified,  may  indicate  enlargement  of  the  bronchial  glands. 

The  enlarged  bronchial  glands  often  escape  detection  by 
percussion,  owing  to  vibration  of  the  sternum  and  spinal 
column. 

Insomuch  as  the  method  of  vibrosuppression20  is  of  great 
value  in  topographic  percussion  of  the  chest,  brief  reference 
will  be  made  to  it  at  this  time. 

If  one  percusses  the  normal  chest,  say  beneath  the 
clavicle,  a  sound  is  produced  which  is  the  product  of  the 
vibration  of  the  lung  tissue  and  the  thoracic  walls.  It  is 

80 


V    i    b    r    o    s    u    p    p    re    s    s    i    o    n 


f    /  i  fl    rn 

f ,      /          ;!    i    S 

\1    '  (il  i 


FIG.  32. — The  vibrosuppressor  and  its  application  to  the  chest 


Spondyloth     e    r    a   p    y 

the  summation  of  this  vibration  which  interferes  with  the 
elicitation  of  the  dullness  of  the  airless  organs  in  juxtaposition 
to  the  lungs.  If  the  vibration  in  question  can  be  eliminated, 
the  definition  of  the  viscera  will  prove  easy  of  attainment. 
Briefly,  lung  resonance  is  made  up  of  two  chief  factors,  viz., 
vibration  of  the  air  in  the  lungs  and  vibration  of  the  sternum. 
The  latter  is  essentially  a  sounding-board.  Thoracic  vibra- 
tion can  be  eliminated  as  far  as  possible  by  percussion  of 
the  organs  at  the  end  of  a  forced  expiration,  when  there  is 
comparatively  little  air  in  the  lungs  to  vibrate,  and  by  sup- 
pressing the  vibrations  of  the  sternum  by  means  of  the 
vibrosuppressor  (Fig.  32). 

The  apparatus  is  modeled  after  a  tourniquet,  consisting 
of  a  pelote,  screw,  band  (6  cm.  wide)  and  clamp  for  fixing 
the  latter.  It  is  so  applied  that  the  pelote  rests  on  the 
xiphoid  cartilage  of  the  sternum.  The  pelote  is  made  to 
compress  the  cartilage  by  aid  of  the  screw  with  all  the  pressure 
the  patient  can  tolerate.  Percussion  is  then  executed  during 
the  time  the  apparatus  is  employed  and  preferably  during 
suspended  respiration  after  forced  expiration.  In  the 
absence  of  the  apparatus,  firm  pressure  made  on  ike  lower 
end  of  the  sternum  by  the  hand  of  an  assistant  will  aid  topo- 
graphic percussion  during  the  time  the  patient  has  suspended 
respiration  after  forced  expiration.  More  recently,  the 
author  has  noted  that  suppression  of  the  vibrations  of  the 
spinal  column  by  aid  of  compression  of  the  latter  by  the  hand 
of  an  assistant  is  of  material  aid  in  percussing  enlarged 
bronchial  glands  and  defining  the  lower  border  of  the  liver, 
spleen  and  stomach.  In  many  instances  it  is  better  to  com- 
press the  sternum  and  spine  simultaneously. 

Among   other   signs   of   enlarged   glands   are   those   of 
Grancher  (unilateral  restriction  of  breathing)  and  Petruschky 
(area  of  tenderness  between  the  shoulder  blades). 
« ^  82 


Backache 
CHAPTER  IV. 

SUMMARY  OF  SPINAL  DISEASES  AND  SYMPTOMS. 

BACKACHE — CHEST  DEFORMITIES — COCCYGODYNIA — FAULTY  ATTITUDES 
— LITIGATION  BACKS — LUMBAGO — NEUROTIC  SPINE — OSTEO-ARTH- 
RITIS — POTT'S  DISEASE  OF  THE  SPINE — SACRO-ILIAC  DISEASE — 
SACRO-ILIAC  RELAXATION — SPINAL  CURVATURES — SCOLIOSIS — 
KYPHOSIS  AND  LORDOSIS — ANGULAR  CURVATURE — SPONDYLITIS — 
SPONDYLOLISTHESIS — TRAUMATISM  OF  THE  SPINE — TUMORS  OF 
THE  SPINE — TYPHOID  SPINE — VERTEBRAL  INSUFFICIENCY — DIAG- 
NOSIS OF  SPINAL  DISEASES — PAINS — DEFORMITY — COMPRESSION 
OF  THE  SPINAL  CORD — PARAPLEGIA — TUBERCULOSIS — SYPHILIS — 
GONORRHOEA — RHEUMATISM — RICKETS — SPINAL  MENINGITIS. 

BACKACHE. 

/T>HE  popular  conception  of  the  etiology  of  backache  in 
•*•  men  is  the  kidney,  and  in  women  pelvic  disease. 

As  a  matter  of  fact  the  kidney  and  pelvis  are  infrequently 
concerned  in  the  etiology  of  this  common  affection. 

It  is  practically  axiomatic  that  organic  heart-lesions  as 
a  rule  are  dissociated  with  pain  and  the  same  may  be  said 
of  the  average  renal  disease. 

I  adopt  the  following  simple  manceuver  for  excluding 
the  kidneys  as  factors  in  the  causation  of  backache :  Place 
the  pleximeter  first  over  one  and  then  over  the  other  kidney 
in  the  lumbar  region  and  practice  forcible  concussion.  The 
hands  (Fig.  3)  may  be  employed  for  a  similar  purpose. 

By  aid  of  this  transmitted  palpation  of  the  kidneys  no 
pain  can  be  elicited  in  the  norm,  but  if  the  pain  from  which 
the  patient  suffers  is  of  renal  origin  the  exact  nature  of  it  may 
be  reproduced  by  this  manceuver.  This  method  of  trans- 
mitted palpation  is  equally  efficient  in  determining  the  sen- 
sitiveness  of  the  liver. 

83 


S    p     ondylotherapy 

The  lumbar  muscles  (lumbago)  are  commonly  concerned 
in  the  etiology  of  backache  and  they  must  be  excluded  in 
diagnosis  (page  99). 

When  the  muscles  in  question  are  involved,  bending  far 
forward  suddenly  will  stretch  the  muscles  and  elicit  pain. 

Backache  dependent  on  pelvic  or  renal  disease  would  be 
uninfluenced  by  such  a  movement. 

It  must  be  remarked,  however,  that  the  latter  movement 
and  pain  in  LUMBAGO  are  influenced  by  the  muscles  involved. 
Thus,  involvment  of  the  erectors  permits  bending  forward, 
but  elicits  pain  when  the  vertebral  column  is  straightened; 
when  the  flexors  (quadratus  and  psoas)  are  involved,  bending 
forward  is  painful  and  rotation  of  the  thigh  (psoas)  causes 
distress ;  when  the  serratus  posticus  is  involved,  deep  breath- 
ing and  not  spinal  movements  causes  pain. 

Backache  may  be  located  in  the  lumbar,  lumbo-thoracic, 
sacral  or  coccygeal  regions. 

In  women,  the  neurotic  spine,  sacro-iliac  disease,  con- 
stipation, hemorrhoids  and  pelvic  disease  are  frequent  causes 
of  backache.  If  CONSTIPATION  is  present  in  either  sex  the 
pain  is  located  in  the  regions  of  the  ascending  and  descending 
colon  and  is  associated  with  tympanites.  The  expulsion  of 
gas  brings  temporary  relief  and  the  same  may  be  said 
of  carminatives,  purgatives,  enemata  and  a  diet  (non- 
amylaceous)  which  inhibits  the  formation  of  gastro-intestinal 
gases. 

In  GASTRIC  TYMPANITES,  backache  may  be  felt  in  the 
left  interscapular  region.  The  writer  has  shown23  how 
easily  the  heart  may  be  dislocated  by  distension  of  the  stom- 
ach. It  is  unnecessary  to  descant  on  the  practical  value  of 
this  observation.  Heart-dislocation  from  stomach-dilatation 
is  associated  with  a  circumscribed  area  of  dullness  in  the 
left  interscapular  region.  Over  this  area,  bronchial  respira- 

84 


B 


a 


a 


tion  is  heard.  When  the  patient  leans  far  forward,  dullness 
and  bronchial  breathing  disappear  to  reappear  when  the 
erect  attitude  is  resumed  (Fig.  34). 

The  foregoing  syndrome  may  be  reproduced  synthetically 
by  artificial  distension  of  the  stomach.  An  enormously  dis- 
tended heart  may  produce  identical  signs. 

Artificial  insufflation  of  the  colon  is  incapable  of  producing 
the  same  degree  of  cardiac  luxation.  In  gas tro -intestinal 
affections,  notably  ulcerative  in  character,  pain  in  the  back 


FIG.  33. — Radioscopic  appearance  of  the  heart  before  and  after  the  admin- 
istration of  a  Seidlitz  powder.  The  silhouette  of  the  heart  is  represented  by  the 
dark  area. 

often  ensues  within  a  few  minutes  after  the  ingestion  of  fluids 
and  food. 

I  have  employed  the  phrase  RESPIRATORY  ATAXIA,  to 
designate  many  respiratory  neuroses  which,  in  my  experience, 
are  associated  with  a  defective  type  of  breathing  and  with 
inco-ordination  of  the  muscles  of  respiration.  In  males, 
the  type  is  costal  instead  of  abdominal,  and  in  women, 
abdominal  instead  of  costal.  These  patients  have  one 
symptom  in  common:  A  paroxysmal  tendency  to  "catch 
the  breath."  There  are,  however,  other  symptoms,  notably 
backache,  syncope,  dyspnea,  cardiac  palpitation  and  insomnia. 

85 


Spondyloth     e    r    a    p    y 


Mere  inspection  makes  the  diagnosis,  viz.,  the  recognition 
of  the  reversed  type  of  breathing.  Auscultation  elicits  no 
respiratory  murmur  in  the  lower  lobes  of  the  lungs  in  males 
and  the  upper  lobes  in  females.  Encircling  the  chest  with 
a  rubber  bandage  to  exclude  costal  breathing  and  the  abdo- 
men in  females  to  exclude  abdominal  respiration  brings 
immediate  relief,  whereas  re-education  of  the  type  of  respira- 
tion results  in  cure. 


FIG.  34. — Patch  of  dullness  and  area  of  bronchial  respiration  in  dislocation 
of  the  heart  upward  after  artificial  distension  of  the  stomach.  The  adjoining 
illustration  shows  an  increase  in  the  area  of  dullness  when  the  same  patient  is 
leaning  backward. 

A  nasal  anomaly  may  be  the  exciting  factor  and  this  may 
be  demonstrated  by  the  immediate  relief  of  the  symptoms 
following  cocainization  of  the  nasal  mucosa. 

HEMORRHOIDS  may  induce  reflex  pains  running  to  the 
back  but  more  often  down  the  left  leg,  thus  simulating 
sciatica.  As  a  rule  such  hemorrhoids  have  abraded  surfaces 
and  for  this  reason,  an  ointment  containing  a  large  percentage 
of  orthoform  is  effective  as  a  local  anesthetic  and,  in  this 
action  a  diagnosis  may  be  made. 

If,  for  instance,  the  pains  in  the  back  are  ameliorated 

86 


B         a 


a 


after  the  application  of  the  salve  to  the  hemorrhoid,  we  know 
that  the  latter  is  concerned  in  the  etiology  of  the  pains. 
More  radical  measures  addressed  to  the  cure  of  the  hemorr- 
hoids are  equally  efficient  and  the  author  can  highly  recom- 
mend the  daily  application  of  Monsel's  solution  to  the  hem- 
orrhoids by  means  of  a  brush  once  or  twice  daily. 

Other  rectal  affections,  notably  fissures,  may  be  excluded 
by  the  local  application  of  a  5  or  10  per  cent  solution  of 
cocain. 

One  must  also  think  of  the  POST -OPERATIVE -BACKACHE 
provoked  by  the  straight  dorsal  position  of  the  patient  during 
a  protracted  operation.  This  may  be  prevented  by  flexing 
the  limbs  and  body  and  using  cushions  under  the  shoulders, 
knees  and  small  of  the  back  during  an  operation. 

Rose21  directs  attention  to  a  chronic  PERIOSTITIS  of  one 
of  the  spinal  processes  (lumbar  and  sacral  usually)  as  an 
important  cause  of  backache.  The  latter  may  be  detected 
by  the  pain  produced  by  pressure  with  the  finger  on  the 
implicated  spine.  Immediate  relief  is  secured  by  one  appli- 
cation of  leeches  to  the  spinal  process  and  cure,  by  the  daily 
application  of  iodine-tincture  and  potassium-iodid  internally. 
When  over-distended  SEMINAL  VESICLES  cause  backache, 
immediate  relief  is  often  achieved  by  stripping  the  vesicles. 

PROSTATIC  DISEASE  may  cause  backache  which  is  often 
misinterpreted  as  sciatica  or  lumbago.  This  is  due  to  the 
intimate  association  existing  between  the  pudic  nerve  from 
which  the  prostate  receives  its  spinal  fibers  and  the  roots 
of  the  lumbar  and  sacral  plexuses. 

A  PENDULOUS  ABDOMEN  may  cause  backache  and  this 
may  be  demonstrated  by  the  relief  secured  by  raising  the 
abdominal  walls  with  both  hands.  If  the  latter  manceuver 
is  effective,  a  proper  abdominal  support  must  be  worn. 
Here  the  pain  is  probably  caused  by  traction  of  the  mesentery 

87 


S    p     o    n    d    y    I    o    t    h     e     r    a   p   y 

on  the  spine.  The  drag  of  the  abdomen  in  obese  subjects 
will  cause  lordosis  and  strain  on  the  sacro-iliac  articulations. 

In  chronic  APPENDICITIS  backache  may  be  present  and 
is  increased  in  severity  after  fatigue.  Byron  Robinson  has 
shown  that  the  appendix  is  frequently  in  contact  with  the 
psoas  muscle  and  may,  therefore,  be  bruised  by  the  action 
of  this  muscle.  With  the  patient  in  the  recumbent  posture 
sudden  extension  and  flexion  of  the  thigh  on  the  trunk  will 
often  elicit  severe  pain.  On  the  other  hand,  the  pain  is 
relieved  when  'both  thighs  and  knees  are  partly  flexed  in 
recumbency. 

ANEURISM  of  the  thoracic  aorta  is  characterised  by  sharp 
paroxysmal  and  lancinating  pains.  Anginal  attacks  are  not 
infrequent  when  the  aneurism  is  located  at  the  root  of  the 
aorta.  The  pains  often  radiate  down  the  left  arm,  up  the 
neck  or  along  the  upper  intercostal  nerves.  In  aneurism 
involving  the  descending  aorta,  one  of  the  most  frequent 
symptoms  is  pain  and  Huchard,  referring  to  this  form  of 
aneurismal  neuralgia,  says  that  when  one  is  dealing  with 
persistent  pain  of  long  duration  which  cannot  be  explained, 
which  resists  ordinary  medication  and  which  is  either  in- 
creased or  diminished  in  severity  in  certain  attitudes  of  the 
patient,  one  should  always  consider  aneurism  as  a  probable 
diagnosis  and,  if  no  tumor  can  be  demonstrated,  one  must 
have  recourse  to  the  x-rays  for  additional  evidence  in 
diagnosis. 

If  backache  is  caused  by  PELVIC  DISEASE,  palpation  of 
the  ovaries  and  movements  of  the  uterus  should  reproduce 
the  pains  from  which  the  patient  suffers.  The  pain  from 
uterine  affections  is  often  located  in  the  upper  sacrum  and  is 
described  generally  as  a  dragging  sensation.  In  such 
instances  retro -flexion  is  the  most  common  cause. 

Referring  to  the  pains  of  pelvic  inflammations,  Kelly 

88 


Backache 

makes  the  following  pertinent  observation:  Inflammatory 
pain  has  a  definite  habitat.  .  .  .  The  pain  of  inflamma- 
tion is  a  fixed  point ;  it  is  never  in  one  place  to-day  and  then 
at  some  remote  part  of  the  body  to-morrow,  one  day  in  the 
shoulder  and  the  next  in  the  foot  or  calf  of  the  opposite  leg. 
.  .  .  .  It  is  a  safe  working  hypothesis  to  conclude  that 
a  patient  who  complains  of  a  definite  pain  and  who  from 
day  to  day  and  week  to  week  is  definite  in  her  complaint  as 
to  the  character  and  seat  of  the  pain,  has  some  gross  lesion. 
Garrigues22  divides  pelvic  backaches  into  two  varieties : 

1.  When  pain  and  tenderness  are  located  at  the  4th  and 

5th  lumbar  vertebrae  (spinal-center  for  the  internal 
pelvic  organs) ; 

2.  When  a  tender  spot  can  be  located  on  either  side  of 

the  2nd  sacral  vertebra. 

The  latter  variety  is  caused  by  a  cellulitis  of  the  utero- 
sacral  ligaments. 

Garrigues  contends  that  in  the  norm  the  utero -sacral 
ligaments  are  so  elastic  that  the  uterus  can  be  brought  for- 
ward bimanually  until  arrested  by  the  pubic  bones.  When 
the  ligaments  are  inflamed,  any  movement  of  the  uterus 
forward  causes  acute  pain  in  the  baek. 

Many  persistent  backaches  in  women  owe  their  origin 
to  improper  methods  of  DRESS.  Here  an^  important  element 
is  the  pressure  of  corsets. 

In  the  developmental  period  of  some  of  the  ACUTE 
INFECTIONS,  notably  small-pox,  dengue  and  influenza,  back- 
ache is  a  frequent  concomitant,  the  pathology  of  which  is 
obscure. 

Associated  with  what  is  known  as  INDURATIVE  HEAD- 
ACHE (which,  according  to  Edinger,  is  regarded  as  the  most 
frequent  form  of  headache)  there  are  also  pains  in  the  neck 

89 


S  p    o    n    d    y    I    o    the    r    a    p    y 

and  back  caused  by  indurations  within  the  bodies  of  the 
muscles  due  to  a  chronic  myositis. 

The  indurations  are  painful  on  palpation  and  may  feel 
like  grains  of  shot.  They  are  most  frequently  located  in  the 
muscles  of  the  head  and  neck,  although  other  sites  are  not 
exempt  (Fig.  35). 


FIG.  35. — The  most  common  sites  of  indurations  (modified  from  Edinger  by 
Yawger). 

Several  months  may  be  necessary  to  effect  a  cure  and 
this  may  be  attained  l)y  removal  of  the  indurations  by  means 
of  vibration  and  Gal vano -therapy  but  most  effectually  by 
massage. 

This  subject  is  more  exhaustively  discussed  elsewhere.38 
One  must  remark,  however,  that  fibrous  indurations  are 

90 


B          a          c          k          a          c          h          e 

not  essentially  rheumatic  insomuch  as  they  may  also  follow 
infections  and  local  injuries  or  strain  of  the  muscles.  In  my 
experience,  the  indurations  are  best  detected  by  relaxing  the 
affected  muscle  and  then  rubbing  the  skin  with  vaselin  when 
firm  pressure  with  the  finger  will  demonstrate  the  nodules. 
After  a  few  seances  of  massage  the  indurations  will  become 
more  defined. 

Depage,  of  Brussels,  directs  attention  to  the  infrequency 
of  backache  (in  10  to  15  per  cent  of  the  cases)  in  floating 
kidney  (nephroptosis)  and  observes  that,  notwithstanding 
nephrorrhaphy,  the  pains  in  the  back  continue.  Here,  as  in 
backache  referred  to  other  causes,  the  following  condition 
has  been  overlooked  by  clinicians,  viz.,  owing  to  deformity 
of  the  ribs,  the  loth  or  nth  rib  comes  in  contact  with  the 
crest  of  the  ilium  either  on  one  side  or  the  other  and  the 
rubbing  thus  provoked  gives  rise  to  a  dull,  intermittent  pain 
which  is  accentuated  by  movements.  The  false  position  of 
the  ribs  may  occur  as  a  result  of  scoliosis.  The  loth  and 
nth  ribs  are  painful  on  palpation  and  there  is  little  or  no 
space  between  the  lower  ribs  and  the  crista  ilei.  Resection 
of  the  anterior  ends  of  the  ribs  in  question  resulted  in  cure 
when  mechanotherapeutic  methods  failed.55 

SYNOPTIC  TABLE  OF  BACKACHES.* 

DISEASES  OF  THE  SPINAL  CORD. 
LOCATION  OF  PAIN.  CONCOMITANT  SYMPTOMS. 

In  distal  parts  of  the  body  de-  No  spinal  rigidity  nor  vertebral  ten- 
pendent  on  the  pain-fibers  that  derness.  Dependent  on  the  seg- 
are  irritated.  ment  of  the  cord  involved,  motor 

and    sensory    disturbances    are 
present  with  loss  of  reflexes. 

*The  essential  facts  of  this  table  have  been  gleaned  from  a  paper  by  Dr.  C.  M. 
Cooper  of  San  Francisco,  which  was  kindly  placed  at  the  disposal  of  the  author 
prior  to  its  publication. 

91 


Spondyloth 


r    a    p    y 


DISEASES  OF  THE  SPINAL-ROOTS  AND  MEMBRANES. 


May  occur  either  in  juxtaposition 
to  the  lesion  or  in  distal  parts 
and  is  intense  and  shooting  in 
character. 


Pains  occur  in  definite  anatomic 
zones  and  are  inclined  to  encircle 
half  the  trunk  or  shoot  into  the 
extremities.  Spinal  rigidity  and 
tenderness  are  usually  absent, 
thus  excluding  vertebral  disease. 
If  a  single  nerve-root  is  involved 
it  may  be  the  precursory  symp- 
tom of  herpes, 

DISEASES  OF  THE  VERTEBRAL  COLUMN. 


Pains  are  root-like  in  character 
with  or  without  vertebral  ten- 
derness. 


Deformity  may  or  may  not  be 
present.  Usually  spinal  rigidity 
and  impaired  mobility  corre- 
sponding to  the  vertebrae  impli- 
cated. The  nature  of  the  spon- 
dylitis  (q.  v.)  must  be  determined. 

EXTRA- VERTEBRAL  ARTICULAR  DISEASES. 

Pains  may  be  confined  to  the  Backache  is  worse  in  the  recumbent 

region  of  the  ribs,  scapulae  or  posture  and  referred  pains  in- 

ilia.     In  abnormal  sacro-iliac  nervated    by    the    lumbo-sacral 

mobility   (vide  sacro-iliac  dis-  cord  are  frequent, 
ease),  pain  is  referred  to  the 
sacro-iliac  joints  or  sacrum. 

DISEASES  OF  THE  MUSCLES  AND  LIGAMENTS  OF  THE  BACK. 

Usually  described  under  the  gen-  Rigidity  of  the  back-muscles  may 
eric  term  lumbago.  Pains  are 
increased  by  movements  which 
contract  the  muscles.  Muscles 
tender  when  compressed  by 
the  fingers.  The  Faradic  cur- 
rent is  useful  in  diagnosis 
(page  99). 

BACKACHES  FROM  STATIC  ERRORS. 

In  taking  the  strain  off  of  distal  The  diagnosis  is  established  when 

anomalies,    the    muscular   fa-  the    flat-foot   or   knock-knee    is 

tigue    graduates    into     pains.  remedied    by    some    orthopedic 

Rotary    or    lateral    curvature  manceuver. 
may  be  present. 


be  present  but  no  pain  can  be 
elicited  by  percussion  of  the 
vertebrae  and  there  are  no  nerve- 
root  pains. 


B 


a 


a 


BACKACHES  FROM  VISCERAL  DISEASE. 


The  visceral  stimuli  may  be: 

1.  Spasm  in  a  hollow  muscular 
organ  (ureteral  colic); 

2.  Distension  of  a  capsule  (en- 
larged spleen,  liver  or  kid- 
ney) 

3.  Inflamed    serous    coverings 

(adherent  appendix) ; 

4.  Insufficient  blood  supply  (ab- 
dominal arteriosclerosis) ; 

5.  Excessive  functioning  (exces- 
sive venery) ; 

6.  Pressure  (tumors  and  aneur- 
isms) ; 

Visceral  pains  are  dissociated  with 
excessive  vertebral  tenderness  or 
stiffness  or  by  movements  which 
call  the  fasciae  and  ligaments  into 
play  as  in  lumbago. 


Usually  referred  pains,  which  are 
sharp,  aching  or  stabbing. 
Hyperesthesia  over  zones  cor- 
responding to  the  areas  inner- 
vated by  the  disturbed  spinal- 
segments  (Figs.  23,  24,  25  and 
26)  and  tenderness  and  rigidity 
of  the  muscles  innervated  by 
the  same  segment.  Location  of 
pain  suggests  organ  involved: 
i,  between  the  shoulders, 
gastric  pains;  2,  right  shoulder 
blade  or  tip,  hepatic  disease; 
3,  left  shoulder  blade,  over- 
loaded heart;  4,  dorso-lumbar 
region,  varicocele,  loaded  colon, 
ovarian  or  testicular  disease;  5, 
angle  between  lowest  rib  and 
erector  spinae  muscle,  kidney- 
stone;  6,  loin,  kidney  disease;  7, 
base  of  sacrum,  prostatic  or 
uterine  disease;  8,  sacro-iliac 
synchondrosis,  distended  sem- 
inal vesicles,  inflamed  utero- 
sacral  ligament,  pelvic  and 
rectal  diseases. 

SPECIAL  BACKACHES. 

1.  POST -OPERATIVE    BACKACHE. — After   operations   in 
the  supine  posture  due  to  improper  support  of  lumbar  arch 
with  muscular  relaxation  during  anesthesia.     The  backache 
in  women  occurring  at  night  is  due  to  improper  support  of 
the  lumbar  arch  and  may  be  prevented  by  a  pillow  under 
the  loins  during  sleep. 

2.  PROFESSIONAL    BACKACHE. — Observed    in    dentists 
and  surgeons  who  assume  a  constrained  posture  and  the 

93 


S    p     ondyloth     e     r    a   p    y 

remedy  consists  in  raising  the  right  leg  and  placing  the  right 
foot  on  a  stool ;  thus  the  lumbar  spine  is  partly  unarched  and 
strain  is  removed  from  the  stretched  ligaments. 

3.  HYSTERICAL  BACKACHE. — vide  hysterical  spine. 

4.  COCCYGODYNIA  (page  95). 

CHEST-DEFORMITIES. 

The  configuration  of  the  thorax  is  frequently  modified  as 
a  sequence  of  curvature  of  the  spine  and  the  deformities 
are  as  follows  :  kyphotic,  scoliotic  and  scolio-kyphotic. 
Such  deformities  are  readily  recognized  by  the  short  thorax^ 
low  stature  and  the  exaggerated  breadth  of  the  shoulders. 

The  RACHITIC  chest  is  especially  characterized  by  the 
keel -shaped  prominence  of  the  sternum  (pigeon-breast) 
and  may  be  associated  with  deformities  of  the  spine,  notably 
scoliosis  and  kyphosis.  The  BOAT-SHAPED  chest  (thorax  en 
batteau)  has  only  been  observed  in  syringomyelia  and 
consists  of  a  depression  in  the  median  line  of  the  upper 
portion  of  the  anterior  chest -wall. 

In  the  ALAR  or  PTERYGOID  chest  there  are  prominent 
scapulae. 

Projection  of  one  scapula  indicates  the  presence  of  a 
lateral  curvature. 

In  1743,  Hunauld  described  the  condition  known  as 
CERVICAL  RIB.  The  anterior  limb  of  the  transverse  process 
of  the  yth  cervical  vertebra  has  an  independent  center  of 
ossification  and  may  develop  into  a  separate  bone  (known 
as  a  cervical  rib),  which  may  not  extend  beyond  the  trans- 
verse process  or  may  form  a  complete  rib  attached  ante- 
riorly to  the  sternum.  A  cervical  rib  may  be  present  either 
on  one  or  both  sides.  Since  the  employment  of  x-rays  in 
diagnosis,  the  cervical  rib  is  more  frequently  recognized  and 
is  not  an  uncommon  condition  in  explaining  many  vascular 

94 


Coccygodyn 


a 


and  nervous  symptoms  referable  to  the  upper  extremity  and 
neck.  A  supposititious  osseous  growth  of  the  neck  may  be  a 
cervical  rib  or  exostosis  emanating  from  it. 

A  cervical  rib  may  exist  with  or  without  symptoms.  In 
the  former  event,  the  symptoms  are  associated  with  pressure 
on  the  subclavian  artery  (aneurism,  gangrene  of  the  hand 
and  minor  vascular  affections)  and  on  the  brachial  plexus 
(neuritis).  The  symptoms  may  develop  suddenly  in  chil- 
dren and  adults. 

COCCYGODYNIA. 

This  is  a  neuralgia  of  the  coccygeal  plexus  and  is  also 
known  as  coccydynia.  The  chief  sign  of  this  affection  is 
pain  in  and  around  the  coccyx  which  is  accentuated  in  the 
sitting  posture  (sitting -pain),  by  rising,  walking,  urination, 
defecation,  coitus  and  during  pregnancy.  Pressure  on  the 
coccyx  is  painful.  The  pain  may  be  intermittent  or  con- 
tinuous and  dull  or  neuralgic.  With  the  patient  in  the  dorsal 
or  the  left  lateral  position  by  grasping  the  coccyx  between 
the  index  finger  (in  the  rectum)  and  thumb  and  moving  the 
coccyx,  the  pain  from  which  the  patient  suffers  may  be  re- 
produced and  in  this  sense  such  an  examination  is  diagnostic. 

The  affection  is  chiefly  confined  to  women  and  is  occa- 
sionally observed  in  children.  In  quack  literature  the 
affection  is  often  described  as  the  "elongated  spinal  column." 

Occurring  rarely  in  males,  it  owes  its  origin  to  some 
sexual  anomaly. 

The  etiology  is  obscure,  the  predominant  factors  being 
traumatism  (horse -back  riding),  pregnancy,  labor,  rheu- 
matism and  pelvic  diseases. 

Many  writers  regard  the  affection  as  a  neurosis  or 
neuralgia  and  the  success  attending  Graefe's  method  of 
treatment  would  suggest  the  latter  hypothesis  as  correct  in 
the  majority  of  cases.  Graefe  cured  all  his  cases  within 

95 


Spondyloth     e    r    a    p    y 

twelve  seances  by  applying  one  pole  of  the  Faradic  current 
to  the  sacrum  and  the  other  pole  to  the  coccyx  and  surround- 
ing tissues. 

FAULTY  ATTITUDES. 

Above  the  age  of  twelve  years  the  normal  attitude  may 
be  roughly  estimated  by  aid  of  the  plumb-line  held  against 
the  back  of  the  sacrum;  this  line  approximates  the  con- 
vexity of  the  dorsal  spine. 

The  FLAT  BACK  is  observed  in  children  with  a  tendency 
to  scoliosis  and  the  HOLLOW  BACK  (lordosis),  unless  due  to 
disease,  is  usually  an  anomaly  of  conformation.  ROUND 
SHOULDERS  are  associated  with  the  following  attitude :  head 
is  flexed  and  carried  forward,  the  shoulders  are  drooping, 
the  chest  is  narrow  and  flat,  the  scapulae  are  prominent  and 
the  physiologic  curve  in  the  dorsal  region  is  accentuated. 
The  age  of  puberty  is  the  usual  time  for  the  occurrence  of 
round  shoulders.  The  etiology  is  identified  with  general 
muscular  weakness  (especially  of  the  posterior  shoulder- 
muscles),  defective  hygiene,  supporting  the  clothing  from 
the  shoulders  in  lieu  of  the  waist,  and  protracted  spinal 
flexion  from  incorrect  school  furniture  which  lends  no  sup- 
port to  the  back. 

In  PARALYSIS  AGITANS  the  attitude  is  characteristic: 
head  and  body  are  bent  forward  with  trunk  flexed  on  thighs 
and  fore-arms  on  the  arms.  The  other  essential  points  in 
diagnosis  are :  tremor  at  rest  ceasing  upon  voluntary  move- 
ments, mask -like  face,  monotonous  voice  and  rigidity  of 
the  back. 

In  CERVICAL  CARTES  the  head  is  held  to  one  side,  supported 
by  one  or  both  hands  in  a  fixed  position.  In  PSEUDO- 
HYPERTROPHIC  MUSCULAR  PARALYSIS,  the  enlarged  though 
feeble  muscles,  and  the  attitude  (legs  far  apart,  shoulders 

96 


Litigation      Backs 

thrown    back,    abdominal    protrusion    and    lordosis)    are 
characteristic. 

In  SHOULDER  MALPOSITIONS,  with  drooping  of  the 
shoulder  forward,  rotation  of  the  scapula  lowers  the  glenoid 
cavity,  thus  causing  the  humerus  to  rest  against  the  ribs  and 
by  so  doing,  the  axillary  structures  are  compressed,  resulting 
in  circulatory  disturbances  in  the  hand  and  pains  in  the 
distribution  of  the  brachial  plexus. 

LITIGATION  BACKS. 

As  a  result  of  accident,  many  individuals  suffer  from 
symptoms  referred  to  the  back  which  in  reality  do  not  exist 
and  which  often  evanesce  after  a  favorable  verdict  by  a  jury. 

It  is  easier  for  a  patient  to  simulate  a  disease  which 
gives  little  objective  evidence,  hence  the  nervous  system  is 
a  prolific  field  for^he  malingerer. 

Simulation  of  organic  nervous  disease  is  extremely  diffi- 
cult, and  for  this  reason,  the  symptomatic  picture  is  essentially 
neurasthenic.  Simulation  can  only  be  excluded  by  the 
physician  after  a  thorough  objective  examination  of  the 
nervous  system.  The  behavior  of  the  patient,  when  his 
attention  is  diverted  from  his  symptoms,  must  be  carefully 
noted.  Disease  of  the  cord  and  membranes  may  be  excluded 
if  the  reflexes  are  intact  and  if  there  is  no  distal  spasm, 
paralysis  or  anomaly  of  sensation. 

Vertebral  implication  is  excluded  if  there  is  no  vertebral 
tenderness,  deformity  or  limitation  of  spinal  movement. 

If  unilateral  spasm  is  present  it  cannot  be  feigned. 

In  real  PARALYSIS,  any  change  in  the  condition  of  the 
muscles  cannot  be  feigned.  In  simulated  paralysis,  move- 
ment of  the  involved  limb  may  show  some  muscular  stiffness 
if  it  is  suddenly  raised  or  dropped,  or,  if  motion  is  secured  by 

97 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

painful  stimuli  such  as  the  prick  of  a  pin  or  a  powerful 
Faradic  current. 

Under  anesthesia  the  patient  may  execute  movements  of 
a  simulated  paralyzed  extremity  and  in  one  case  of  malinger- 
ing, the  author  induced  the  malingerer  to  move  his  limb 
during  hypnosis. 

ANESTHESIA  is  easier  of  simulation  than  the  preceding 
symptom,  for  the  reason  that  sensibility  varies  even  in  the 
norm.  Thus  women  are  more  tolerant  to  pain  than  men 
and  even  in  healthy  criminals  analgesia  is  frequently  ob- 
served. Polish  Jews  are  said  to  show  anomalies  in  the  per- 
ception of  pain.  Bailey25  asserts,  that  there  are  many  in- 
dividuals who  can  suppress  any  evidence  of  pain  as  long  as 
their  attention  is  fixed  upon  this  object. 

The  "human  pin  cushions"  in  museums  really  suffer 
pain,  but  in  consideration  of  the  salary  they  receive,  willingly 
submit  to  the  thrusts  of  the  pin. 

In  making  a  sensory  examination,  the  eyes  must  be  blind- 
folded and  the  tests  must  be  executed  without  any  fixep 
system.  Thus,  when  one  leg  is  being  examined,  prick  the 
anesthetic  leg  quickly  or  employ  a  Faradic  current  and 
suddenly  use  the  full  force  of  the  battery.  Again,  mark  with 
a  pencil  on  the  skin  the  areas  of  anesthesia  and  examine 
later  to  observe  if  the  areas  correspond. 

Feigned  anesthesia  is  not  limited  to  the  exact  distribution 
of  the  peripheral  nerves,  nor  to  the  sensory  distribution  of 
the  spinal -segments. 

To  determine  objectively  the  existence  of  PAIN,  the  signs 
noted  on  page  70  may  be  employed. 

The  REFLEXES  are  not  under  control  of  the  will,  hence, 
if  modified  or  lost,  feigning  may  be  excluded.  It  is  true, 
however,  that  the  knee-jerk  may  be  inhibited  if  the  patient 
firmly  contracts  the  knee -muscles. 

98 


L  u  m  b  a  g 


LUMBAGO. 

A  muscular  rheumatism  (myalgia)  limited  to  the  muscles 
of  the  loins  and  their  tendinous  attachments  is  known  as 
lumbago. 

An  attack  of  lumbago  may  occur  suddenly  after  stooping, 
or  a  sudden  twist,  hence"  the  phrase,  "kink  in  the  back"  or 
"Hexenschuss"  (witches'  shot),  as  the  Germans  call  it. 

The  differentiation  of  pain  located  in  the  muscles  or 
vertebral  ligaments  is  often  difficult  of  attainment,  yet,  one 
may  say,  that  if  the  pain  is  worse  in  straightening  up,  the 
erector  spinae  muscles  are  involved,  whereas  implication  of 
the  ligaments  is  probably  present  when  the  greatest  pain  is 
experienced  when  the  patient  bends  far  forward. 

Schreiber  notes  than  an  intense  dull  pain  extending  from 
the  sacrum  to  the  3rd  dorsal  vertebra  dissociated  with  any 
limitations  in  the  movements  of  the  spine,  indicates  the 
involvement  of  the  fascia  lumbo-dorsalis.  Difficult  bending 
forward  suggests  implication  of  the  flexor  muscles  (psoas 
and  quadratus).  Involvement  of  the  psoas  is  indicated  by 
the  pain  evoked  in  rolling  the  thigh  outward.  Pain  in  the 
region  of  the  4th  and  yth  ribs  uninfluenced  by  bending  the 
spine  but  accentuated  by  breathing,  suggests  involvement 
of  the  serratus  posticus. 

In  general,  muscular  pain  is  diagnosed  when  the  muscles 
are  tender  on  pressure  and  passive  stretching  or  active  con- 
traction accentuates  the  pain. 

When  the  muscles  cannot  be  grasped  between  the  fingers, 
muscular  contraction  may  be  provoked  by  the  Faradic 
current  and  after  this  manner,  the  areas  of  sensitiveness  may 
be  elicited.  This  current  is  therefore  equally  efficient  in 
differentiating  myalgia  from  pains  of  other  origin. 

Myalgia,    in   contradistinction  to   neuralgia,  shows   no 

99 


S   p     ondyloth     e     r    a    p    y 

periods  of  exacerbation,  but  becomes  accentuated  from 
pressure  and  active  and  passive  movements  and  the  muscles 
may  show  changes  in  volume  and  consistency.  From 
vertebral  disease,  the  diagnosis  is  usually  not  difficult  (vide 
backache).  It  must  be  emphasized,  however,  that  per- 
sistent lumbago  mav  be  a  symptom  of  masked  Pott's  disease. 

Lumbago  caused  by  fatigue  is  ameliorated  by  massage, 
which  removes  the  fatigue-toxins. 

Myalgia  may  also  be  provoked  by  an  intramuscular 
neuritis  or  by  pressure  on  the  intramuscular  nerves  by  the 
indurated  connective  tissue  of  the  muscles  (page  89). 

Myalgia  of  rheumatic  origin  yields  to  the  salicylates 
and  when  associated  with  a  toxemia  dependent  upon  some 
digestive  anomaly,  small  doses  of  calomel  followed  by  a 
saline  is  an  effective  measure. 

Strapping  would  be  equally  efficient  in  pain  of  muscular 
or  vertebral  origin,  whereas  acupuncture  (page  146),  if 
efficient,  is  practically  diagnostic  of  a  myalgia. 

By  means  of  strips  of  adhesive  plaster  (preferably  zinc 
oxid)  properly  applied  to  the  lumbar  muscles  without  in- 
cluding the  spine,  immediate  relief  is  often  obtained  in 
myogenic  pain.  Almost  miraculous  in  action  is  freezing 
(page  172)  of  the  skin  overlying  the  affected  muscles.  Unless 
relief  is  immediate  after  the  use  of  freezing  no  results  can 
be  expected  from  its  repetition. 

Myalgia  of  gouty  origin  demands  the  employment  of 
remedies  addressed  to  the  gouty  state. 

In  URIC  ACID  LUMBAGO  dependent  on  a  supposed  pre- 
cipitation of  uric  acid  in  the  muscles  of  the  back  the  local 
application  of  OIL  OF  WINTERGREEN  (by  massage)  is,  accord- 
to  Haig,  both  diagnostic  and  curative.  For  purposes  of 
massage  I  employ  an  electric  massage-apparatus,  which  is 
illustrated  in  Fig.  36. 

100 


u 


m 


a 


The  author  does  not  seriously  consider  the  so-called 
uric-acid  theory  of  disease,  yet  he  feels  that  in  a  book  of  this 
character,  he  dare  not  obtrude  his  personal  opinion  nor 


FIG.  36. — Electric  massage-apparatus  for  inunction. 

demolish  a  theory  which  has  won  favor.  Therefore,  a  few 
words  are  pertinent  respecting  this  theory.  Many  causes 
have  been  assigned  for  the  uric -acid  diathesis,  but  in  reality 

101 


Spondyloth 


r    a   p    y 


the  essential  cause  may  be  thus  summarized:      excessive 
eating  and  drinking  with  deficient  muscular  exercise. 

There  is  practically  no  known  remedy  for  eliminating 
uric -acid  from  the  blood  and  one  is  constrained  to  have 
recourse  to  a  diet  with  the  object  of  diminishing  the  ingestion 
of  foods  containing  uric  acid.  Adams  suggests  the  following 
diet-lists  in  cases  of  uric-acid  intoxication. 


MAY   BE   EATEN. 


White  Meat  of  Chicken,  Sparingly. 
Fat  Bacon  or  Fat  Pork  or  Ham. 
Macaroni,  Spaghetti,  Vermicelli. 
Barley,     and     all     .Cereals     and 

"Flaked"  Breakfast  Foods. 
Potatoes  in  all  forms  but  Fried. 

Sweet  Potatoes. 
Kale  and  Spinach,  Sparingly. 
Flounders,   Fresh   Cod,   Hake  or 

Haddock. 

Fresh  Fish,  Soup  or  Chowder. 
Vegetable  Soups,  with  Barley. 
Game,  once  a  week,  Sparingly. 
Cheeses  of  all  kinds.   Very  useful. 
Stale  Bread,  Crackers,  etc. 
Rusks,  Cake  without  Eggs. 


Raw  Cabbage,  "Slaw." 
Corn  on  the  Cob  or  from  the  Tins. 
Cucumbers,  Lettuce,  Parsley. 
Dandelion,      Beet      and      other 

"Greens." 

Beets,  Turnips,   Squash,  Pump- 
kins. 
Puddings  of  Crackers,  Bread,  etc., 

without  eggs. 
Rice,  Sago,  Tapioca. 
Milk,        Buttermilk,        "Cereal 

Coffees." 
Chestnuts,    Almonds,     Walnuts, 

Pecans,  Grapes,  Raisins,  Figs, 
Apple    Sauce,    Pears,    Lemons. 

Grape  Fruit,  Oranges. 
Dried  Fruits  in  Sauces,  Sweetened 

only  when  cold  and  ready  to  eat. 


TO   BE   AVOIDED 


Eggs,  and  foods  containing  them.      Pickled,  Salted  or  Preserved  Fish. 


Beef. 
Veal. 
Pork. 

Mutton. 

Lamb. 

Beef  Tea. 

All  Soups  made  with  Meats. 


Salmon,  Bluefish,  Mackerel  or  any 

Oily  Fish. 
Mushrooms. 
Celery,  Kale. 
Tomatoes,  Rhubarb. 
New  Bread  or  Biscuit. 
Made  Dishes,  as  Puddings  with 


102 


Neurotic      Spine 

Potted  or  Preserved  Meats.  Eggs. 

Lobsters,  Crabs,  Clams,  Oysters.  Hot  Griddles,  Waffles,  etc. 

Dark  Meat  of  Chicken  or  Fowl.  Beer,    Wine,    Whiskey    and    all 

Liver,  Sweetbreads,  Kidneys,  etc.  Alcoholics. 

Beans,  Peas  or  Lentils,  Dried,  in  Tea,  Coffee,  Cocoa  andChocolate. 

Soups  or  Baked.  Peanuts. 
Bananas,  Gooseberries. 

TRAUMATIC  LUMBAGO  often  follows  injuries  of  the  verte- 
bral column  and  is  dependent  on  strain  or  laceration  of  the 
tissues  which  protect  the  spinal  cord.  Injury  of  the  spinal 
cord  is  excluded  by  the  absence  of  paralysis,  anesthesia  and 
loss  of  sphincter -power.  In  this  form  of  lumbago  there  is 
pain  in  the  back,  aggravated  by  motion.  Painful  areas  may 
be  detected  over  the  vertebral  spines  and  muscles,  and 
the  latter  are  usually  in  a  condition  of  spasm. 

Vide  osteo -arthritis  (page  105)  which  is  often  falsely 
designated  as  lumbago. 

NEUROTIC  SPINE. 

In  hysteria  and  neurasthenia,  spinal  symptoms  may  pre- 
dominate conducing  to  a  condition  known  as  spinal  irritation 
or  spinal  neurasthenia.  Among  the  symptoms  are :  weak- 
ness and  pain  in  the  back  and  intercostal -like  neuralgic 
pains,  which  shoot  down  the  legs. 

The  rachialgia  may  only  appear  after  exhaustion  or 
movements  of  the  spine  or  it  may  occur  spontaneously.  In 
practically  all  cases  areas  of  tenderness  may  be  elicited  on 
the  spine. 

The  diagnosis  of  the  neurotic  spine  is  based  on  the 
diagnosis  of  neurasthenia  and  hysteria. 

In  neurasthenia,  the  chief  symptom  is  tire,  without  which 
sign  the  disease  cannot  be  said  to  exist. 

Amyosthenic  symptoms  are  present  (page  52),  and  it  is 

103 


S    p     ondylotherapy 

evident,  that  if  the  back -muscles  (which  are  the  only  agents 
in  maintaining  the  spine  erect)  are  involved  in  the  hypo- 
tonicity,  backaches  must  be  of  frequent  occurrence. 

Respecting  the  diagnosis  of  hysteria,  one  searches  for 
the  stigmata  (anesthesia,  hyperesthesia,  etc.). 

According  to  the  modern  conception  of  hysteria,  the  so- 
called  stigmata  are  of  artificial  production,  evoked  by  the 
suggestion  of  the  physician  during  his  examination;  hence 
the  stigmata  are  characterized  by  mobility,  variability  and 
incertitude.* 

If  anesthesia  is  present  it  may  be  revealed  by  certain 
manceuvers.  In  the  method  known  as  TRANSFERENCE,  if  a 
coin  or  any  metal  is  placed  on  an  anesthetic  area,  the 
latter  will  show  a  return  of  sensibility,  whereas  another  area 
with  normal  sensibility  may  become  anesthetic.  The 
manceuver  may  be  reversed  by  placing  the  coin  over  an  area 
of  normal  sensibility;  this  in  turn  becomes  anesthetic  and 
sensibility  is  restored  in  another  anesthetic  area. 

Janet  suggests  an  ingenious  manceuver.  The  patient, 
let  us  assume,  has  an  anesthetic  area  on  the  back.  He  is 
told  to  say  "yes"  each  time  he  feels  the  prick  of  the  pin  and 
"no"  when  it  is  not  felt.  The  examination  must  be  con- 
ducted rhythmically  so  as  to  give  the  patient  no  previous 
warning.  If  the  patient  says  "no"  when  the  anesthetic  area 
is  touched,  the  nature  of  the  anesthesia  is  revealed  insomuch 
as  the  patient  could  not  say  "no"  if  tactile  sensation  were 
not  present.  In  hysteria,  the  psychic  origin  of  the  disturbed 
sensations  is  further  revealed  by  the  fact  that  they  bear  no 
relation  to  the  distribution  of  the  sensory  nerves  nor  to  the 
segments  of  the  spinal  cord. 

The  neurotic  spine  is  frequently  associated  with  diseases 

*This  conception  merits  modification  in  traumatic  neuroses  (page  377). 

104 


0    s     t    e     o     -Arthritis 

of  the  pelvis  insomuch  as  areas  of  hyperesthesia  are  fre- 
quently located  over  the  ovaries  (ovarian  tenderness). 

In  the  majority  of  instances  the  ovaries  are  not  implicated 
and,  if  bimanual  examination  of  the  pelvis  is  made  and  the 
finger  in  the  vagina  is  made  to  approximate  the  finger  on  the 
area  of  tenderness,  it  can  easily  be  demonstrated  that  the 
pain  is  located  in  the  abdominal  walls  and  not  in  the  pelvic 
organs. 

OSTEO  -ARTHRITIS . 

Synonyms. — Rheumatoid  Arthritis ;  Arthritis  Deformans ; 
Chronic  Rheumatic  Arthritis ;  Rheumatic  Gout. 

In  this  affection  pronounced  structural  changes  in  the 
joints  and  cartilages  are  present.  When  the  spine  is  in- 
volved, there  is  hypertrophy  and  overgrowth  of  bone. 

The  x-rays  have  been  a  valuable  aid  in  the  recognition 
of  these  changes  which,  when  present,  exclude  rheumatism, 
insomuch  as  the  latter  affection  is  unattended  by  pathologic 
alterations  in  the  cartilage  and  bone. 

The  affection  usually  occurs  between  the  ages  of  thirty 
and  fifty  years  and  women  (notably  those  who  have  pelvic 
disease  or  are  sterile)  are  as  frequently  affected  as  males. 

The  affection  is  neither  related  to  rheumatism  nor  gout. 

It  was  formerly  held,  that  the  disease  was  dependent  on 
lesions  of  the  spinal  cord  owing  to  the  occurrence  of  muscular 
atrophy,  pain,  neuritis,  increase  of  reflexes,  etc.,  but  the 
modern  theory  is  in  favor  of  a  chronic  infection  resulting 
from  gonorrhea,  influenza  and  other  infectious  diseases.  In 
children,  Still  has  described  a  form  characterized  by  en- 
largement of  the  joints  and  swelling  of  the  lymph -glands 
and  spleen.  The  onset  usually  occurs  before  the  second 
dentition  and  girls  are  more  frequently  affected  than  boys. 
The  children  are  puny  and  show  arrest  of  development. 

105 


S    p     ondylotherapy 

Nathan48  describes  a  metabolic  form  of  osteo-arthritis 
which  is  characterized  by  a  symmetrical  involvement  of  many 
joints  with  swelling  and  increasing  deformity.  Radiograms 
show  a  peculiar  punched -out  rarefaction  in  the  early  stages, 
and  absorption  and  distortion  in  the  late  stages  without  the 
presence  of  proliferative  processes  or  bony  ankylosis.  It  is 
interesting  to  observe  that  in  such  cases  the  employment,  of 
the  thymus  shows  a  remarkable  effect.  One  begins  with  two 
five-grain  tablets  thrice  daily.  In  a  couple  of  weeks  the 
dose  is  increased  to  three  tablets  and  after  a  month  three 
tablets  four  times  a  day  are  given. 

A  toxemic  factor  has  been  recognized  in  the  etiology  of 
arthritis  deformans  and  treatment  directed  toward  a  pyorrhea 
alveolaris  or  albuminous  putrefaction  of  the  intestines  has 
been  followed  by  satisfactory  results.  In  the  latter  condition, 
indicanuria  is  present.  Intestinal  putrefaction  is  combated 
by  interdicting  meat  in  the  diet,  the  use  of  intestinal  anti- 
septics, the  employment  of  laxatives  to  produce  daily  move- 
ments of  the  bowels  and  the  use  of  soured  milk  (one  or  two 
pints  daily).  The  latter  may  be  substituted  by  tablets 
containing  lactic  acid  bacilli,  but  care  must  be  taken  that  the 
products  are  reliable.* 

It  is  the  VERTEBRAL  form  of  this  "affection  which  is  of 
particular  interest  to  us.  Here  there  is  a  progressive 
ankylosis  of  the  vertebrae  conducing  to  spinal  rigidity  (poker- 
back).  This  condition  has  been  described  as  SPONDYLITIS 
DEFORMANS, of  which  there  are  two  varieties;  that  of  Von 
Bechterew,  which  is  either  hereditary  or  secondary  to  a 
trauma  in  which  nerve-root  symptoms  (anesthesia,  pain  and 
muscular  atrophy)  predominate  and  the  spine  alone  is 
involved.  In  the  Strumpell-Marie  type,  also  known  as 

*This  subject  is  more  fully  discussed  on  page  344. 

106 


0    s     t    e     o     -Arthritis 

SPONDYLOSE  RHizoMELiQUE,  the  spinal  signs  are  less  char- 
acteristic and  the  shoulder-joints  may  be  involved  as  well  as 
the  hip. 

When  the  spine  in  the  lumbar  region  is  involved,  the 
pains  may  simulate  sciatica  or  lumbago;  in  the  cervical 
region  the  pains  are  referred  to  the  neck  and  arms  and  in 
the  dorsal  region  along  the  intercostal  nerves. 

My  friend,  Dr.  S.  J.  Hunkin,  who  has  had  an  extensive 
experience,  contends  that  probably  most  lumbagos  and 
sciaticas  are  of  osteo-arthritic  origin.  Spondylitis  deformans 
is  about  three  times  as  frequent  in  men  as  in  women  and  the 
ages  of  predilection  are  from  twenty-five  to  forty-five  years. 

The  LABORER'S  SPINE  (duplicature  champetre  of  Marie), 
occurring  in  laborers  who  must  adopt  the  stooping  posture, 
must  not  be  confused  with  this  affection.  In  the  laborer's 
spine,  the  entire  spine  is  never  "welded  together"  and  there 
is  no  exostosis  nor  decided  ankylosis  of  the  joints  of  the 
extremities. 

In  the  diagnosis  of  osteo-arthritis,  mention  has  been 
made  of  the  x-ray  plate  for  revealing  the  osseous  overgrowth. 
The  latter  may  also  be  revealed  by  palpation,  which  shows 
thickenings  or  nodes. 

If  the  affection  implicates  the  spine,  the  range  of  motion 
is  limited  and  the  lordotic  curve  instead  of  ending  at  the  loth 
or  nth  dorsal  vertebra,  runs  up  to  the  yth  or  8th  dorsal 
vertebra  or  perhaps  higher  (Hunkin).  Involvement  of  the 
vertebrae  is  further  noted  by  limitation  of  the  hip -movements 
and  stiffness  of  the  back.  The  normal  curves  are  accentu- 
ated, notably  the  lumbar  and  dorsal  ones,  and  the  patient  is 
bent  in  walking.  If  there  is  any  ankylosis  between  the  ribs 
and  the  spine  the  breathing  is  abdominal,  owing  to  deficient 
expansion  of  the  chest.  Diminution  or  absent  chest-expan- 
sion shows  implication  of  the  articulation  of  the  ribs. 

107 


Spondyloth     e    r    a    p    y 

If  there  is  any  motion  in  the  spine  it  is  painful  and  may 
be  associated  with  crepitus.  It  is  necessary  to  distinguish 
loss  of  motion  due  to  muscular  spasm  and  locking  of  the 
joints  by  the  osteophytes. 

Little  nodules  (Heberden's  nodosities)  may  be  felt  upon 
the  sides  of  the  distal  phalanges. 

Although  this  disease  is  regarded  as  incurable,  thiosinamin 
may  be  tried  or  anesthesia  employed. 

Fibrolysin  is  preferable  to  thiosinamin  and  is  used 
hypodermatically.  The  drugs  in  question  soften  scar  tissue. 

Anesthesia  is  effective  for  a  dual  reason ;  if  the  ankylosis 
is  fibrous  it  may  be  forcibly  overcome. 

Again,  Marshall26  has  recently  shown  the  following  re- 
action after  ether-anesthesia  in  the  usual  manner  from  a  cone 
for  fifteen  minutes  in  osteo-arthritis  without  apparent  in- 
fection ;  complete  subsidence  of  pain,  restored  motion  in  the 
involved  joints  and  partial  disappearance  of  periarticular 
swellings.  Amelioration  may  not  occur  for  twenty-four 
hours  and  the  relief  between  anesthesia  and  the  return  of 
pain  is  from  two  days  to  two  weeks.  Acute,  show  more 
decided  changes  than  chronic  cases.  If  the  patient  is  made 
worse  by  the  anesthesia  the  arthritis  is  probably  of  infectious 
origin.  The  therapeutic  value  of  repeated  anesthesias  was 
not  determined,  owing  to  the  insufficient  number  of  cases. 

Relief  of  pain  in  the  early  stages  of  the  disease  is  secured 
by  fixation  of  the  spine,  but  later,  such  immobilization  is 
not  indicated  owing  to  ankylosis,  which  must  be  prevented 
by  active  and  passive  movements. 

POTT'S  DISEASE  OF  THE  SPINE. 

This  refers  to  a  progressive  tuberculosis  of  the  vertebral 
bodies  or  discs,  eventuating,  as  a  rule,  in  ankylosis  and  kyph- 
osis.  The  disease  is  localized  in  order  of  frequency  as 

follows : 

108 


0 


D     i     s      e     a 


i. — Dorsal; 

2. — Lumbar; 

3. — Cervical  portion  of  the  vertebral  column. 

The  great  majority  of  cases  occur  before  the  age  of  four- 
teen years  and  one  or  several  vertebrae  may  be  simultaneously 
involved.  The  disease  is  equally  common  in  the  male  and 
female.  Heredity,  traumatism  and  the  diseases  of  children 
which  enervate  the  vitality,  are  frequent  etiologic  factors. 

The  tuberculous  lesion  in  this  disease  is  usually  located 
in  the  body  of  the  vertebra  leading  to  disintegration  of  the 
osseous  structure  which  may  terminate  in  caries  or  suppura- 
tion. In  consequence  of  softening  and  absorption  of  the 
vertebrae  they  cannot  sustain  the  superimposed  weight,  hence 
deformity  (kyphosis)  results. 

When  the  disease  involves  the  last  vertebra,  the  deformity 
resulting  causes  the  lower  lumbar  vertebrae  to  project  over 
the  brim  of  the  pelvis  like  a  roof  (vide  spondylolisthesis). 

MUSCULAR  SPASM  is  an  early  and  characteristic  symptom 
manifested  by  anomalous  attitudes,  lateral  deviations  of  the 
column  and  reduced  flexibility  of  the  spine. 

Muscular  rigidity  is  so  important  an  early  sign  that  the 
following  rules  of  Lloyd27  are  apropos: 

1.  If  stiffness  is  present  when  the  patient  is  told  to  nod 

the  head  affirmatively,  there  is  occipitoatloid 
disease. 

2.  If  stiffness  is  noted  when  the  patient  is  directed  to 

look  far  to  the  right  or  to  the  left,  there  is  atlo- 
axoid  disease. 

3.  When  the  shoulders  are  firmly  fixed  to  the  back  of 

the  chair  and  the  eyes  are  carried  back  along  the 
ceiling,  any  stiffness  suggests  disease  below  the 
second  cervical  vertebra. 

4.  Place  the  patient  prone  on  the  lap  and  indicate  the 

tip  of  each  spinous  process  with  a  pencil,  after 

109 


Spondyloth     e     r    a    p    y 

which  direct  the  child  to  stand  straight  and  note 
if  any  of  the  pencil-marks  approximate;  if  two 
or  more  marks  do  not  approach  each  other  ap- 
proximation is  prevented  by  rigidity  and  the 
disease  is  in  the  dorsal  region. 

5.  To  detect  lumbar  rigidity,  place  the  nude  patient 
upon  a  couch  and  grasp  the  ankles  and  raise  the 
pelvis.  If  the  lumbar  spine  is  flexible  the  pelvis 
is  lifted  without  raising  the  chest  from  the  couch 
and  the  movement  deepens  the  hollow  of  the 
loin.  If  the  lumbar  spine,  however,  is  stiff,  the 
trunk  is  raised  and  there  is  no  alteration  of  the 
outline  of  the  lumbar  spines.  In  Pott's  disease, 
when  the  child  is  directed  to  pick  up  an  object 
from  the  floor,  the  knees  (not  the  back)  are  bent. 

PAIN,  usually  dull,  may  be  located  at  the  site  of  the 
disease  or  referred  to  the  peripheral  distribution  of  the 
irritated  nerves,  and  it  is  for  the  latter  reason,  that  the  child 
may  be  treated  for  some  visceral  affection. 

Bilateral  pains  (sciatica  and  intercostal  neuralgia)  are 
suggestive  of  vertebral  disease  and  chronic  bilateral  belly- 
aches in  children  are  diagnostic  according  to  Lloyd.  Pain 
and  tenderness  in  the  back  suggest  abscess -formation.  Very 
often  the  pain  of  dorsal  disease  may  be  assuaged  by  raising 
the  shoulders  and  in  cervical  disease  by  lifting  the  head. 

DEFORMITY,  especially  when  angular  and  in  the  median 
line,  is  pathognomonic  of  this  disease.  Angular  deformity 
is  noted  more  often  in  regions  where  the  normal  curves  are 
posterior  than  when  they  are  anterior. 

A  skiagram  is  invaluable  in  the  early  diagnosis  of  Pott's 
disease. 

When  the  disease  has  subsided,  there  is  no  longer  any 
tenderness  of  the  spine  to  vertical  pressure,  and  jarring  of 
the  column  in  various  ways  causes  no  inconvenience.  Rigidity 

110 


Sacro-Iliac      Disease 

may  continue  as  a  result  of  the  welding  together  of  the 
affected  vertebrae. 

In  adults  and  less  often  in  children,  Pott's  disease  may 
occur  without  deformity  and  the  only  symptoms  may  be 
the  signs  of  a  spinal  abscess  and  implication  of  the  cord 
and  spinal  roots. 

SACRO-ILIAC  DISEASE. 

Synonyms. — Sacro-coxitis ;  Sacro-coxalgia. 

This  is  either  an  acute  or  chronic  tuberculous  disease  of 
the  sacro-iliac  articulations,*  commencing  either  in  the 
synovial  membrane  or  bone,  and  is  practically  identical  with 
Pott's  disease  of  the  spine.  It  occurs  most  frequently  in 
early  adult  life  and  the  predisposing  cause  is  identified  with 
occupations  (equestrians)  exposing  the  joints  to  traumatism. 

The  pain  in  this  disease  may  be  confined  to  the  affected 
joint  or  may  be  referred  to  the  distribution  of  the  dorsal  or 
sciatic  nerves.  It  usually  begins  on  getting  up  after  a  night's 
rest  and  is  accentuated  by  all  movements  which  jar  the 
joint.  Examination  per  rectum  will  reveal  tenderness  over 
the  joint.  The  pathognomonic  sign  is  the  following :  pain 
in  the  joint  when  the  sides  of  the  pelvis  are  pressed  together. 
In  walking,  the  steps  are  cautiously  made  to  avoid  all  jars 
to  the  joint  and  the  patient  walks  chiefly  upon  the  ball  of 
the  foot  and  the  body  is  inclined  toward  the  sound  side 
with  tilted  pelvis.  Examination  of  the  joint  shows  swelling 
and  elevation  of  local  temperature. 

SACRO-ILIAC  RELAXATION. 

The  sacro-iliac  joint  is  a  true  joint  and  may  be  the  site 
of  the  same  diseases  as  other  joints. 

*The  two  superior  posterior  spinous  processes  of  the  ilium  are  on  a  line  with  the 
third  sacral  spine,  below  which  are  the  sacro-iliac  joints. 

Ill 


Spondyloth     e    r    a    p    y 

Goldthwait,28  refers  many  backaches  in  women  to 
luxation  of  the  sacro-iliac  joints.  Even  in  the  norm,  the 
latter  show  definite  motion  which,  during  pregnancy  and 
menstruation,  is  augmented.  These  joints  are  also  relaxed 
in  consequence  of  traumatism  and  general  weakness.  The 
so-called  "stitch"  in  the  back,  from  strain  or  overwork, 
represents  a  strain  of  the  joint  in  question.  The  backache 
occurring  in  the  morning  after  sleep  and  after  operations  is 
referable  to  the  general  relaxation  following  the  dorsal 
posture  which  strains  the  lumbar  spine  and  draws  the  sacrum 
backward. 

It  is  suggested  that  the  backache  thus  produced  is  com- 
monly relieved  by  stretching  upon  first  waking,  which  draws 
the  lumbar  spine  forward. 

Drag  of  the  abdomen  in  obese  individuals  is  often  a 
source  of  sacro-iliac  weakness  in  consequence  of  the  lordosis 
and  pelvic-joint  strain. 

The  most  frequent  symptom  in  sacro-iliac  relaxation  is 
backache  referred  either  to  the  sacro-iliac  articulations  or 
the  sacrum.  The  backache  may  develop  during  sleep,  owing 
to  the  recumbent  posture.  The  lumbo -sacral  cord  passes 
directly  over  the  upper  part  of  the  sacro-iliac  articulation 
and  the  pressure  thus  induced  accounts  for  the  referred  pains 
in  the  lower  extremities.  Objectively,  one  may  note  when 
the  patient  stands,  an  obliteration  of  the  lumbar  curve  of 
the  spine. 

The  diagnosis  of  sacro-iliac  relaxation  is  often  made  by 
the  therapeutic  results.  Thus  relief  at  night  is  attained  by 
lying  on  a  firm  bed  with  a  firm  hair-pillow  under  the  hollow 
of  the  back.  If  the  joints  are  strained  or  only  relaxed,  some 
support  to  the  pelvic  bones,  like  adhesive  straps  or  a  wide 
webbing  belt  fixed  to  the  base  of  the  corsets  and  kept  up 
by  the  insertion  of  light  steels,  may  be  employed.  If 

112 


Spinal     Curvatures 

luxation  of  the  upper  part  of  the  sacrum  is  present,  it  may  be 
corrected  by  extending  the  spine;  legs  on  one  table  and 
head  and  shoulders  on  another  table  with  the  face  downward 
and  the  unsupported  body  hanging  between.  After  this 
manner,  the  sacrum  is  replaced  and  a  plaster- jacket  is 
applied. 

Sacro-iliac  relaxation  is  frequently  confounded  with 
sciatica  and  lumbago.  It  is  differentiated  from  the  former, 
by  the  absence  of  pain  on  pressure  along  the  sciatic  nerve 
and  from  the  latter,  by  the  absence  of  pain  on  pressure  over 
the  lumbar  muscles  and  free  motion  of  these  muscles.  In 
the  diagnosis  of  relaxation  of  the  sacro-iliac  joint,  one  must 
not  forget  that  a  rectal  examination  will  often  reveal  a  tender 
point  on  either  or  both  sacro-iliac  joints.  If  certain  move- 
ments cause  pain  and  the  cause  is  sacro-iliac  relaxation, 
the  same  movements  may  be  made  without  pain  during  the 
time  the  sides  of  the  pelvis  are  compressed  by  the  hands  of 
the  physician. 

SPINAL  CURVATURES. 

The  curves  of  the  normal  spine  have  already  been  dis- 
cussed (page  39).  The  chief  varieties  of  curvature  are: 

1.  Scoliosis  or  lateral  curvature. 

2.  Posterior  curvature,  also  known  as  kyphosis,  gib- 

bosity or  excurvation. 

3.  Lordosis  or  anterior  curvature. 

4.  Angular  curvature  from  caries  of  the  spine. 

SCOLIOSIS. 

This  refers  to  a  lateral  deviation  of  the  spinal  column 
with  or  without  rotation  of  the  vertebrae  on  their  vertical 
axes. 

Scoliosis  is  the  most  frequent  of  all  orthopedic  affections 

113 


Spondyloth     e     r    a    p    y 

and  is  more  common  in  girls  than  in  boys  (four  to  seven 
girls  to  one  boy). 

The  largest  percentage  of  cases  occurs  before  the  age  of 
fourteen  years  and  very  few  cases  occur  thereafter. 

The  most  frequent  curve  is  toward  the  right  in  the  dorsal 
region,  owing  to  the  fact  that  the  right  is  used  more  often 
than  the  left  arm. 

Scoliosis  is  usually  acquired  and  the  most  frequent  causes 
are  general  muscular  debility  and  rickets. 

Scoliosis  may  result  from  an  empyema  with  adhesions 
and  the  concavity  of  the  curvature  is  toward  the  affected  side. 
Caries  and  spinal  tumors  may  eventuate  in  scoliosis. 

In  SCIATICA,  scoliosis  is  frequent,  the  body  being  in- 
clined toward  the  healthy  side  (convexity  of  the  spinal 
column  toward  this  side)  or,  more  rarely,  the  trunk  is  inclined 
toward  the  affected  side,  or  even  more  rarely  the  trunk 
may  alternate  in  being  inclined  toward  one  side  and  again 
toward  the  other  side  (alternating  sciatic  scoliosis).  The 
probable  cause  of  scoliosis  in  sciatica  is  unilateral  reflex 
contractures  of  the  muscles  of  the  back. 

Other  varieties  of  scoliosis  are : 

1.  HABIT  SCOLIOSIS,  due  to  habitual  faulty  positions, 

and  in  this  category  may  be  included  vocational 
scoliosis  resulting  from  faulty  postures  during 
occupation  and  observed  in  dentists,  barbers, 
dressmakers  and  others. 

2.  STATIC  SCOLIOSIS,  due  to  inequality  as  a  result  of 

alterations  in  the  extremity.  Thus,  in  shortening 

of  one  leg  an  obliquity  of  the  pelvis  results  in 

the  opposite  direction  with  a  primary  deviation 
of  the  lumbar  vertebrae. 

It  is  not  difficult  to  recognize  scoliosis  when  all  the 
clothing  is  removed  and  the  child  stands.  Scoliosis  is  made 

114 


Spinal     C    u    r    v    a    t    u 


res 


evident  by  marking  the  spinous  processes  with  an  anilin 
pencil.  Numerous  scoliosometers  are  used  for  measuring 
and  recording  the  degree  of  the  deformity. 

It  may  happen  that  in  neurasthenics,  the  spines  of  the 
vertebrae  are  tender  on  pressure  and  here  mistakes  arise  in 
the  incorrect  diagnosis  of  spinal  caries.  In  the  latter 
affection,  spinal  rigidity  is  the  essential  factor  in  diagnosis 
due  in  the  early  stages  to  involuntary  muscular  spasm  and 
in  the  latter  stages  to  ankylosis. 

When  the  spine  is  flexible  and  curvature  can  be  combated 
by  manipulation,  the  case  is  one  of  scoliosis.  Scoliotic  curves 
however,  may  be  rigid,  but  only  after  having  been  present 
for  many  years. 

There  are  cases  of  functional  lateral  deviation  of  the 
spine  which  are  easily  corrected  and  must  not  be  confused 
with  true  scoliosis.  In  the  latter,  flexion  of  the  spine  in- 
creases the  deformity  and  in  the  former  it  is  obliterated. 
Functional  deviation,  if  neglected,  may  be  converted  into  a 
true  scoliosis. 

Respecting  prognosis  in  scoliosis  one  may  say,  that  when 
there  is  no  deformity  of  the  bones,  i.  e.,  when  the  physician 
can  by  traction  and  manipulation,  correct  the  deformity, 
and  when  the  spinal  muscles  are  intact,  a  cure  can  be  pre- 
dicted. There  is  no  antagonism  between  scoliosis  and  tuber- 
culosis as  was  at  one  time  supposed. 

If  scoliosis  is  caused  by  a  shortened  extremity,  a  thick- 
soled  shoe  is  indicated.  Muscular  nutrition  is  effected  by 
correct  exercises,  massage,  electricity  and  central  sinusoidali- 
zation  (page  158). 

KYPHOSIS  AND  LORDOSIS. 

When  the  normal  dorsal  curve  is  increased  it  is  known 
as  kyphosis  or  posterior  curvature,  and  increase  of  the 

115 


S    p     ondylotherapy 

lumbar  curvature  is  called  lordosis,  anterior  concavity  or 
saddle-back  (Fig.  37).  Compare  the  latter  with  Fig.  16 
showing  the  divisions  and  contour  of  the  normal  spine. 

Kyphosis  and  lordosis  may  co -exist.  Lordosis  is  fre- 
quently an  act  of  compensation  to  counteract  the  center  of 
gravity  going  too  far  forward.  This  compensatory  lordosis 
is  noted  in  pregnancy,  in  obese  individuals,  from  abdominal 
enlargement,  in  rickets,  etc. 

A  paralytic  variety  of  lordosis  is  observed  in  muscular 
atrophy  and  pseudohypertrophic  paralysis. 


FIG.  37. — A,  increase  of  the  dorsal  curve  or  kyphosis;  B,  increase  of  the 
lumbar  curve  or  lordosis. 

Adolescent  kyphosis  is  frequently  noted  in  young  women 
who  have  been  overworked  in  the  workshop  or  field. 

As  a  rule,  the  deformity  cannot  be  overcome  by  voluntary 
effort,  and,  in  consequence  of  compensatory  changes  in  the 
bones,  it  becomes  permanent. 

MUSCULAR  KYPHOSIS  may  result  from  muscular  weakness 
due  to  faulty  attitudes  and  is  observed  in  tailors,  carpenters, 
shoemakers  and  others. 

SENILE  KYPHOSIS  is  caused  by  absorption  occurring  in  the 
intervertebral  discs. 

RACHITIC  KYPHOSIS  is  most  pronounced  in  the  lumbar 
region  and  disappears  in  the  recumbent  posture  and  in 
suspension. 

116 


Spondylitis 

In  all  recent  cases  of  kyphosis,  the  deformity  disappears 
when  the  patient  lies  upon  the  stomach. 

Kyphosis  is  differentiated  from  the  angular  curvature  of 
spinal-caries  by  the  absence  of  rigidity  of  the  spinal-muscles 
and  pains  when  the  vertebral  column  is  percussed. 

LUMBAR  BULGING  must  not  be  confounded  with  kyphosis. 
It  is  usually  a  swelling  on  either  side  of  the  spine  and  is 
commonly  associated  with  some  renal  affection  (tumors, 
pyonephrosis,  etc.). 

ANGULAR  CURVATURE. 

This  may  result  from  any  disease  of  the  vertebral  bodies, 
notably,  tuberculosis,  osteomyelitis,  syphilis,  secondary 
carcinoma  of  the  vertebra,  etc.  Insomuch  as  this  condition 
usually  results  from  tuberculous  caries  of  the  vertebral 
bodies,  the  reader  is  referred  to  the  description  of  Pott's 
disease  (page  108). 

SPONDYLITIS. 

Spondylitis  deformans  has  already  been  described 
(page  1 06). 

The  vertebrae  are  implicated  in  various  diseases  usually 
of  infectious  origin.  The  following  forms  of  spondylitis 
may  be  differentiated. 

i.  TRAUMATIC  SPONDYLITIS. — This  affection  follows  an 
injury  and  bears  a  close"  resemblance  to  Pott's  disease.  The 
vertebrae  between  the  3rd  and  yth  dorsal  are  most  frequently 
implicated.  The  pain  which  is  present  may  be  located  in 
the  injured  area  or  may  be  referred,  and  is  accentuated  by 
pressure  and  movements.  Kyphosis  may  also  be  present. 
The  injury  may  be  associated  with  fracture  and  the  spinal 
cord  may  be  ultimately  involved  in  this  affection.  Whereas 
traumatic  spondylitis  is  non -tuberculous,  it  must  not  be 

117 


S  p    o     n    d    y    I    o    t    h     e    r    a    p    y 

forgotten  that  Pott's  disease  may  follow  traumatism.  In 
tuberculous  disease  of  bone,'  here  as  elsewhere,  the  injury 
creates  an  area  of  least  resistance  in  which  the  bacilli  are 
deposited  or  a  latent  area  of  tuberculosis  may  be  aroused 
into  activity. 

2.  INFECTIOUS  SPONDYLITIS. — This  is  observed  in  actino- 
mycosis,  syphilis,  gonorrhea,  osteomyelitis  and  typhoid  fever 
(page  121 ). 

SPONDYLOLISTHESIS. 

This  refers  to  a  deformity  of  the  spinal  column  produced 
by  the  gliding  forward  of  the  lumbar  vertebrae  in  such  a  way 
that  they  overhang  the  brim  of  the  pelvis  and  obstruct  the 
inlet  of  the  latter  (spondylolisthetic  pelvis). 

It  is  an  uncommon  affection  and  results  from  malforma- 
tion, strain  or  violence. 

The  diagnosis  is  established  by: 

1.  A  history  of  injury  during  the  developmental  period 

with  pain  in  the  lower  part  of  the  back. 

2.  Shortening  of  the  body  in  the  lumbar  region. 

3.  Lordosis  with  separation  of  the  ilia. 

A  like  deformity  of  the  pelvis  known  as  SPONDYLIZEMA 
is  produced  by  caries  of  the  last  lumbar  vertebra  and  the 
top  of  the  sacrum. 

TRAUMATISM  OF  THE  SPINE.* 

It  is  an  undeniable  fact,  that  spinal  injuries  may  prove 
an  exciting  factor  in  the  development  of  many  chronic 
diseases,  notably,  general  paralysis  of  the  insane,  locomotor 
ataxia,  etc. 

Whether  traumatism  can  be  regarded  as  a  cause  of  the 
latter  affections  is  still  a  debatable  question  insomuch  as 

*Vide  litigation  backs  (page  97)  and  neurotic  spine  (page  103). 

118 


S  p 


n    a 


I       T  r 


a    u   m    a    t 


s   m 


they  may  have  existed  unrecognized  prior  to  the  injury. 
Schlesinger,  shows  that  the  symptoms  ascribed  to  a  traumatic 
neurosis  may  be  due  in  many  cases  to  some  pre-existing 
affection.  He  examined  one  hundred  victims  of  various 
accidents  within  ten  days  of  the  accident  and  was  amazed 


FlG.  38. — Relation  of  the  spinal  cord  to  the  surrounding  structures.  V,  body 
of  vertebra;  V1,  spinous  process;  i,  ligament;  2,  vessels;  3,  dura  mater  with  the 
arachnoid  lying  directly  beneath  it;  4,  anterior  root;  5,  posterior  root;  6,  spinal 
ganglion;  7,  ligament  (Dana). 

at  the  large  proportion  of  pathologic  conditions  found.  Only 
twenty-two  of  the  one -hundred  persons  were  found  normal. 

It  is  likewise  difficult  to  dissociate  true  from  fictitious 
nervous  symptoms  following  a  simple  strain  which  is  often 
associated  with  the  term  traumatic  lumbago  (page  103). 

A  spinal  sprain  may  result  from  direct  or  indirect  in- 
juries and  the  lumbar  region  is  usually  involve'd.  According 
to  the  nature  of  the  injury  SPINAL  SPRAINS  may  be  differen- 
tiated as  follows : 

119 


S    p     o     n    d    y    I    o     t    h     e    r    a   p    y 

1.  Simple  sprain. 

2.  Sprain  with  nervous  symptoms. 

3.  Sprain  with  spinal  cord  symptoms. 

The  relation  of  the  spinal  cord  to  the  surrounding 
structures  may  be  noted  in  Fig.  38. 

A  simple  sprain  is  pathologically  associated  with  some 
injury  to  the  spinal-muscles  and  ligaments  or  both.  The 
dominant  symptom  is  pain  moderated  by  rest  and  accen- 
tuated by  motion.  The  spinal-muscles  are  in  a  condition 
of  compensatory  spasm  to  immobilize  the  vertebral  column. 
Areas  of  tenderness  may  be  present  and  simulation  of  pain 
may  be  excluded  by  the  signs  of  Mannkopff  and  Loewi 
(page  70), 

NERVOUS  SYMPTOMS,  usually  neurasthenic  or  hysterical 
in  character,  may  co-exist  with  the  symptoms  of  a  simple 
sprain  and  when  .cord-symptoms  (paralysis,  anesthesia, 
changes  in  the  reflexes,  girdle  pain  and  sphincter-changes) 
follow  the  sprain,  one  must  suspect  concussion  of  the  cord 
(when  the  symptoms  abate  within  a  week),  hemorrhage 
within  the  cord  (hematomyelia)  or  the  development  of  a 
meningitis. 

Simulation  is  a  constant  factor  in  spinal  injuries  and  in 
diagnosis  one  must  not  forget  Charcot's  conception  of  a 
trauma  in  etiology.  The  latter  taught  that  functional 
symptoms  following  an  injury,  were  related  to  like  symptoms 
which  could  be  made  to  appear  and  disappear  by  hypnosis. 
The  shock  of  an  injury  is  tantamount  to  an  hypnotizing  agent 
(suggestion)  which  directs  the  attention  of  the  patient  to 
the  injured  part  and  suggests  the  symptoms  (traumatic 
suggestion}. 

There  are  many  neurologists  who  assume  that  the  symp- 
toms of  a  traumatic  neurosis  can  be  produced  by  one  idea 
and  removed  by  another  idea,  in  other  words,  all  is  referred 

120 


T     y     p      h      o      id      Spine 

to  suggestion  and  that  there  can  be  no  purely  functional 
troubles  in  the  absence  of  anatomic  lesions. 

OSTEOPATHIC  TRAUMATISM. — In  the  author's  experience, 
the  mechanic  manipulations  of  many  osteopaths  often 
conduce  to  severe  spinal  sprains  for,  if  the  osteopath  regards 
a  dislocated  vertebra  as  the  cause  of  disease  or  supposes 
that  a  vertebra  is  compressing  a  vessel  or  nerve,  he  is  in- 
clined to  conciliate  his  conviction  with  more  force  than 
discretion. 

TUMORS  OF  THE  SPINE. 

Tumors  of  the  spine  are  usually  carcinomatous  and  less 
frequently  sarcomatous.  Carcinomata  are  rarely  primary. 
They  are  secondary  in  nature  and  due  most  frequently  to 
metastases  from  carcinomata  of  the  breast  and  occur  there- 
fore with  greater  relative  frequency  in  women. 

Secondary  deposits  in  the  lumbar  spine  are  relatively 
frequent  in  individuals  with  cancer  of  the  breast  and  a  group 
of  symptoms  designated  by  the  term  paraplegia  dolorosa 
accompany  the  deposits,  viz.,  lancinating  pains,  hyperes- 
thesia  and  occasionally  paralysis  of  the  bladder  and  rectum. 

In  malignant  ^disease  of  the  spine  the  following  are 
characteristic  signs :  rapid  course,  cachexia,  local  tenderness 
and  severe  pain,  deformity,  rapid  emaciation  and  anemia, 
absence  of  fever,  paraplegic  symptoms,  antecedent  history 
of  a  malignant  growth  and  localization  in  the  lumbar  region. 

The  iso-hemolytic  power  of  the  serum  may  yet  serve  of 
diagnostic  value  as  a  characteristic  reaction  of  cancer. 

TYPHOID  SPINE. 

Bone-lesions  (periostitis,  caries  and  necrosis)  are  occa- 
sional sequelae  of  typhoid  fever. 

In   1889,   Gibney  described   a  condition  of  the  spine 

121 


Spondylotherapy 

occurring  during  the  course  of  the  disease  in  protracted 
cases  and  more  often  during  convalescence,  in  which  pain 
is  felt  either  in  the  lumbar  or  sacral  regions,  especially  after 
a  slight  injury  or  shock.  Usually  the  condition  is  a  neurosis 
with  a  good  prognosis,  but  in  rarer  instances,  the  pathologic 
process  may  be  a  periostitis  with  or  without  a  subperiosteal 
abscess  or  spondylitis. 

Among  the  symptoms  are  stiffness,  localized  pain  and 
weakness  of  the  back. 

The  total  number  of  cases  thus  far  reported  is  about 
seventy-four. 

VERTEBRAL  INSUFFICIENCY. 

This  condition  has  been  described  by  Schanz  in  individ- 
uals between  the  ages  of  20  and  40  years  who  complained 
of  severe  pains  in  the  back.  The  spinous  processes  of  the 
vertebrae  are  painful  on  percussion  and  the  bodies  of  the 
lumbar  vertebras  are  equally  sensitive.  The  latter  is 
demonstrated  by  deep  abdominal  palpation  when  the  fingers 
attain  a  point  where  the  pulsations  of  the  abdominal  aorta 
are  perceptible.  Another  sign  is  the  difficulty  experienced 
in  changing  the  dorsal  for  the  ventral  posture. 

Vertebral  insufficiency  is  frequentl/  regarded  as  an 
expression  of  neurasthenia  and  often  it  has  been  misin- 
terpreted as  a  tuberculous  spondylitis,  but  the  immediate 
results  of  the  treatment  exclude  neurasthenia  and  spondy- 
litis. Some  of  the  patients  date  the  symptoms  from  the 
moment  corsets  have  been  discarded.  The  treatment  con- 
sists of  rest,  massage  and  particularly  the  use  of  an  orthopedic 
corset. 

ORTHOSTATIC  ALBUMINURIA. — In  this  affection,  which 
occurs  most  frequently  in  children,  albuminuria  is  present 
when  the  patient  is  up  and  about  but  disappears  after  rest 
in  bed.  The  condition  is  not  associated  with  nephritis. 

122 


M    al-Alignment 

Jehle39  regards  lordosis  as  an  invariable  concomitant  of 
this  condition  and  he  has  induced  albuminuria  in  healthy 
children  by  provoking  a  curvature  of  the  spine.  It  is  sup- 
posed that  the  incurved  vertebrae  protrude  into  the  space 
between  the  kidneys,  thus  twisting  them  around  on  a  vertical 
axis  and  causing  circulatory  disturbances.  It  is  further 
assumed  that  when  the  children  are  up,  the  weakness  of  the 
spinal  muscles  causes  a  lordosis.  The  albuminuria  may  be 
corrected  by  a  supporting  corset  or  by  strengthening  the 
muscles  of  the  back  and  by  making  the  sole  of  the  shoe  a 
little  thicker. 

MAL -ALIGNMENT  OF  THE  CERVICAL  VERTEBRAE.51 

As  observed  on  page  42,  our  conception  of  the  movements 
of  the  spine  is  too  limited  and  if  the  current  opinion  is  enter- 
tained, that  the  vertebras  are  firmly  bound  together  to  form 
an  elastic  whole  or  entity,  it  is  impossible  to  credit  such  a 
condition  as  mal-alignment  of  the  cervical  vertebrae  without 
the  presence  of  a  traumatic  dislocation. 

Bates51  observes,  "the  muscles  are  designed  and  attached 
to  each  vertebra  so -as  to  enable  it  to  contribute  its  propor- 
tionate share  to  any  of  the  movements  of  the  neck  as  a  whole, 
and  this  arrangement  guarantees  it  a  certain  amount  of 
individual  mobility;  which  is  needed  for  the  execution  of 
the  more  complicated  motions  of  the  head  and  neck." 

Reference  has  been  made  on  page  47  to  the  author's 
observations  on  spasm  of  the  spinal  musculature  provoked 
by  peripheral  sources  of  irritation.  The  muscles,  in  a 
condition  of  spasm  by  exercising  traction  on  the  cervical 
vertebrae,  may  force  them  out  of  the  normal  alignment. 

Now  the  osteopath  contends  that,  in  consequence  of  the 
spasm  of  the  muscles  and  mal-alignment  of  the  vertebrae, 

123 


Spondyloth     e    r    a   p    y 

compression  of  the  vessels  and  nerves  ensues  which  conduces 
to  definite  systemic  anomalies. 

The  recognition  of  cervical  spasm  and  mal-alignment  is 
not  difficult  The  former  may  be  recognized  by  palpation ; 
the  muscles  are  painful  and  in  a  condition  of  contraction. 

Mal-alignment  is  noted  by  deviations  from  the  normal 
articular  line  of  the  head  and  vertebral  column. 

Dr.  Geo.  Gould  comments  on  the  frequency  of  mal- 
position of  the  head,  torticollis  and  spinal  curvature  due  to 
eye-strain. 

The  author  has  noted  even  in  the  norm  that,  when  the 
physician  directs  a  patient  to  make  strained  movements  of 
the  eyes  (without  moving  the  head),  and  at  the  same  time 
palpates  the  muscles  of  the  neck  on  either  side  of  the  spine, 
the  muscles  in  question  contract  spasmodically.  It  is  not 
difficult  to  conceive  then  that,  if  the  peripheral  irritation  is 
persistent,  the  muscles  can  pass  into  a  state  of  tonic  con- 
traction.* Now  a  bit  of  conservatism  is  necessary  in 
estimating  the  results  attained  in  the  treatment  of  these  cases. 
It  is  difficult  to  conceive,  at  least,  theoretically,  how  any 
manipulation  of  the  muscles  will  bring  benefit  until  the 
source  of  peripheral  irritation  is  eliminated.  However,  one 
must  regard  with  tolerance  the  observations  of  those  who 
contend  that  relaxation  of  the  contracted  muscles  and  re- 
leasing "locked  out  vertebrae"  suffice  to  cure. 

For  the  sake  of  completeness,  the  author  desires  to 
describe  the  methods  employed  by  osteopaths  for  the 
"adjustment  of  muscular  lesions"  and  the  "adjustment  of 
cervical  vertebrae.2  ' 

*Dr.  Louis  C.  Deane,  recently  referred  a  patient  to  me  for  diagnosis,  who  in  con- 
sequence of  a  severe  injury  to  the  head,  suffered  from  diplopia  and  vertigo. 
The  condition  was  one  of  muscular  asthenopia.  In  this  patient  the  muscles 
of  the  neck  were  in  a  state  of  tonic  contraction  and  the  head  almost  approxi- 
mated the  shoulder.  Suggestion  made  during  hypnosis  sufficed  to  remove 
the  diplopia  after  a  single  seance  and  when  corrected  the  head  was  again  held 
in  a  normal  position. 


Vertebral     Adjustment 

ADJUSTMENT  OF  MUSCLES. 

1.  Pressure  with  quiet  and  slight  rotation  usually  in  a 
direction  at  right  angles  to  that  of  the  muscular  fibers. 

2.  Relaxation  is  attained  by  stretching  the  muscle  with 
the  object  of  separating  the  origin  and  insertion  of  the  muscle. 

3.  By  approximating  the  origin  and  insertion  of  the 
muscle. 

The  foregoing  methods  are  infrequently  employed  alone, 
but  are  usually  used  in  combination. 

ADJUSTMENT  OF  CERVICAL  VERTEBRAE. 

1.  With   the   patient   in   the   recumbent   posture,   the 
physician  at  the  head  of  the  table  grasps  with  the  fingers  of 
each  hand  the  tissues  along  the  region  of  the  arches  of  the 
vertebrae  with  the  thumbs  on  the  transverse  processes;  the 
lesion  is  exaggerated  by  pushing  with  the  left  hand  directly 
to  the  right  the  tissues  overlying  the  lateral  arches;  simul- 
taneously the  patient's  head  is  forced  against  the  abdomen 
of  the  physician  to  steady  the  movement.    Next,  reverse 
pressure  is  applied  over  the  right  lateral  arch  and  rotation 
is  achieved  by  movement  of  the  hands  and  body  of  the 
physician. 

2.  With  the  patient  in  the  same  position  as  in  the  fore- 
going method,  pressure  is  effected  after  the  same  manner 
but  the  fingers  on  one  side  and  the  thumb  on  the  opposite 
side  grasp  the  postero -lateral  arches  and  with  the  hand 
upon  the  crown  of  the  head,  manipulation  is  made  for 
purposes  of  rotation.     Pressure  is  made  downward  upon  the 
head  in  the  direction  of  the  axis  of  the  vertebral  column  so  as 
to  fully  relax  the  muscles  and  other  tissues. 


125 


S  p    o    n    d    y    I    o    the     r    a    p    y 

CONGESTION  OF  THE  SPINAL  CORD. 

According  to  some  authorities,  areas  of  vertebral  tenderness 
are  associated  with  congestion  of  the  spinal  vaso-motor 
centers.  The  pathologist,  however,  is  unable  to  confirm  this 
clinical  observation.  On  the  contrary,  anemia  does  cause 
changes  in  the  cell-bodies  of  the  cord  with  degeneration. 
It  is  an  undeniable  fact  that,  any  interference  with  the 
motions  of  the  spine  resulting  from  weakness  of  the  spinal 
musculature  is  associated  with  venous  stasis  which  must 
necessarily  interfere  with  the  nutrition  of  the  cord.  The 
spinal  muscles  in  the  lumbar  region  are  supplied  by  the 
lumbar  arteries  and  in  the  dorsal  region  by  the  intercostal 
arteries.  Branches  from  these  vessels  enter  directly  into  the 
spinal  canal  on  a  level  with  each  vertebra. 

The  SPINAL  VEINS  have  no  valves.  The  venous  plexuses 
upon  and  within  the  spine  are  as  follows :  i .  Those  placeo 
on  the  exterior  of  the  column  (dorsal  spinal  veins;;  2. 
Those  located  in  the  spinal  canal  between  the  vertebrae  and 
the  membranes  (meningo-rachidian  veins);  3.  The 
veins  of  the  vertebral  bodies;  4.  The  veins  of  the  spinal 
cord  (Fig.  39). 

DIAGNOSIS  OF  SPINAL  DISEASES. 

In  the  differential  diagnosis  of  spinal  diseases  the  genesis 
of  PAIN*  and  DEFORMITY  must  be  determined.  Inen  ov>.- 
must  decide  if  the  membranes  and  spinal  cord  are  implicated 
and  also  the  character  of  the  lesion.  The  following  tables 
will  aid  in  the  differentiation  of  pain  and  deformity. 


*Vide  backaches  and  lumbago  (pages  83  and  99). 


Spinal         Veins 


FIG.  39. — The  upper  figure  represents  the  transverse  section  of  a  dorsal 
vertebra  showing  the  spinal  veins.  The  lower  figure  is  a  vertical  section  of  two 
dorsal  vertebrae  showing  the  spinal  veins. 


127- 


S  p    o 


n 


d 


loth 


r    a    p    y 


PAINS. 


DISEASE. 

ANEURISM  (thoracic). 


COMPRESSION  MYELITIS. 


HEP-JOINT  DISEASE. 


CONCOMITANT  SYMPTOMS. 


Sharp  paroxysmal  lancinating  pains 
when  the  aneurism  erodes  the 
vertebrae.  Pain  radiates  down 
the  left  arm,  to  neck  and  up- 
per intercostal  nerves.  Also 
anginoid  pains.  Signs  of  intra- 
thoracic  pressure.  In  spinal 
curvature,  dislocation  of  the 
heart  may  cause  displacement  of 
the  aorta,  causing  the  latter  to 
pulsate  to  the  right  of  the 
sternum. 

Nerve-root  symptoms. — Radiating 
pains,  anesthetic  areas,  trophic 
disturbances  and  atrophy  of  the 
muscles. 

Cord  symptoms. — Cervical  reigon — 
Retropharyngeal  abscess,  spasm 
of  the  cervical  muscles,  dilatation 
of  the  pupil  and  unilateral  flush- 
ing or  sweating. 

Thoracic  region. — Paraplegia  of 
the  spastic  type  (exaggerated 
reflexes)  and  when  the  com- 
pression is  complete  (rare),  re- 
flexes are  abolished. 

Lumbar  region. — Paraplegia  with 
implication  of  the  sphincters. 

Often  confounded  with  lesions  of 
the  lumbar  region.  Pain  in  hip, 
front  of  thigh,  or  at  inside  of 
knee.  Limitation  of  motion  of 
the  hip-joint,  unilateral  atrophy 
of  the  muscles  (especially  the 
adductors) ,  lameness,  swelling 

128 


Spin 


a 


a 


n 


DISEASE. 


INTRASPINAL  TUMORS. 


LATERAL  CURVATURE. 


LEUKEMIA. 


LUMBAGO 


CONCOMITANT  SYMPTOMS. 

confined  to  the  front  and  back  of 
hip-joint  and  attitude  of  limb 
(abducted  and  everted). 

Symptoms  vary  with  the  segment 
involved.  Radiating  pains  from 
the  level  of  the  lesion.  Usually 
paralysis  of  the  leg  on  one  side 
and  sensory  disturbances  on  the 
opposite  side  and  jerking  move- 
ments of  the  lower  extremities. 
A  radiogram  may  show  infiltra- 
tion of  the  vertebrae  by  the 
growth.  At  the  level  of  the 
growth,  pressure  at  the  side  of 
the  spinous  processes  may  elicit 
the  pains  felt  by  the  patient. 

Severe  cases  in  the  lumbar  region 
may  simulate  malignant  disease 
of  the  spine.  The  latter  is  ex- 
cluded by  the  long  duration  of 
the  disease  absence  of  cachexia, 
presence  of  compensatory  curves 
and  the  unilateral  deformity. 

The  sternum  and  spinal  column 
are  exquisitely  tender  on  pres- 
sure. 

Usually  occurs  after  a  sudden 
muscular  effort  in  a  gouty  or 
rheumatic  subject  or  after  ex- 
posure to  cold  or  wet.  Patient 
usually  in  excellent  health  and 
pains  yield  as  a  rule  to  treat- 
ment. Lumbago  resisting  treat- 
ment may  be  symptomatic  of  an 
organic  lesion  of  the  spine 
(Pott's  disease,  tumors). 

129 


Spondylotfi 


r    a   p    y 


DISEASE. 


LOCOMOTOR  ATAXIA. 


NEUROMIMESIS  (Hysteria). 


OSTEOARTHRITIS. 
OSTEOMYELITIS. 


PLEURODYNIA  (Muscular  rheu- 
matism of  the  intercostal  mus- 
cles, pectorals  and  serratus 
magnus; . 


SCIATICA. 


CONCOMITANT   SYMPTOMS. 

Lightning  pains  usually  of  a  few 
seconds  duration  are  most  com- 
mon in  the  legs  and  about  the 
trunk.  History  of  syphilis, 
ataxia,  absence  of  knee-jerk, 
Argyll-Robertson  pupil  and  sen- 
sory disturbances  in  the  legs. 

The  spinal  symptoms  (spinal  irri- 
tation) of  hysteria  and  neuras- 
thenia may  simulate  locomotor 
ataxia.  The  spinal  tenderness  is 
general,  the  pains  are  fugitive 
and  evanescent  and  are  not 
limited  to  definite  anatomic  ter- 
ritories. The  patients  are  usually 
women  and  the  history  is  corrob- 
orative. 

Vide  spondylitis  deformans  (page 
1 06). 

Local  symptoms  of  swelling  and 
rigidity  of  the  spine,  constitu- 
tional symptoms  of  sepsis, 
sudden  in  onset  and  suppuration 
always  occurs.  Usually  second- 
ary to  some  distant  suppurative 
focus. 

Pain  usually  on  left  side  and  accen- 
tuated by  breathing  and  cough- 
ing. Affected  muscles  painful  on 
pressure.  Often  mistaken  for 
pleurisy  and  intercostal  neural- 
gia (page  1 86). 

A  bilateral  sciatica  is  always  sug- 
gestive of  a  cord-lesion,  notably 
pressure  on  the  nerve-trunks  of 
the  cauda  equina.  Sciatica  is 

130 


S    p     in     a     I     D    eformity 


DISEASE. 


SPINAL  MENINGITIS. 


DISEASE. 
ACROMEGALY. 


ANEURISM. 


r^QNDRODYSTROPHIA 

rickets). 


CONCOMITANT  SYMPTOMS. 

often  secondary  to  a  chronic 
arthritis  of  the  spinal  column  and 
may  be  unilateral  in  the  lumbo- 
sacral  roots  in  Pott's  disease. 

The  root-pains  are  often  con- 
founded with  Pott's  disease.  In 
the  latter  disease,  the  root-pains 
are  relieved  by  rest  and  accen- 
tuated by  movement  and  the 
erect  posture.  In  meningitis, 
there  is  a  lymphocytosis  of  the 
cerebro-spinal  fluid,  whereas  in 
Pott's  disease  (tuberculosis  out- 
side of  the  membranes)  the  fluid 
is  normal. 

DEFORMITY. 

CONCOMITANT  SYMPTOMS, 

This  dystrophy  manifested  by 
hypertrophy  of  the  bones  of  the 
face  and  extremities  is  charac- 
terized by  kyphosis. 

Deformity  due  to  eroding  into  the 
bodies  of  the  vertebrae  occurs 
late  in  life  and  other  symptoms 
of  aneurism  co-exist. 


(Fetal 


MALIGNANT 
SPINE. 


DISEASE      OF      THE 


OSTEOMYELITIS  (.vertebral). 


Rigid  kyphosis  without  spasmodic 
muscular  contraction.  Deform- 
ity of  the  chest  and  premature 
ossification  of  the  epiphyses  of 
extremities. 

Deformity  absent  or  rounded  with- 
out bursa.  No  suppuration, 
rapid  course,  cachexia,  severe 
localized  pain  and  paraplegia. 

Acute  onset,  rapid  suppuration, 
constitutional  signs  of  sepsis  and 
rigors. 


S  p     o    n    d    y    I    o    the    r    a    p    y 


DISEASE. 

FACET'S  DISEASE  (Osteitis  defor- 
mans) . 


POTT'S  DISEASE  (caries). 


CONCOMITANT  SYMPTOMS. 

The  dorso-  cervical  kyphosis  is 
associated  with  forward  projec- 
jection  of  the  hea,d,  prominent 
clavicles,  triangular-shaped  face 
and  shortening  of  the  stature. 

Kyphosis  is  sharp  and  angular  and 
usually  gradual  in  development 
with  muscular  rigidity  of  the 
spine. 

Kyphosis  as  a  rule,  when  not  due 
to  caries,  shows  soft  erector 
spinae  muscles  and  the  absence 
of  pain  on  concussion  trans- 
mitted to  the  back. 

PULMONARY  OSTEOARTHROPATHY    Kyphosis  may  be  present.     En- 
(Hypertrophic).  largement  of  the  articular  ends 

of  the  bones,  enlarged  terminal 
phalanges  and  incurvation  of  the 
nails.     Usually  associated  with 
•  i  :  pulmonary  diseases. 


RICKETS. 


SCURVY  (Barlow's  disease). 


SENILITY. 


Kyphosis  most  pronounced  in 
lumbar  region  and  disappears  in 
recumbency  and  suspension. 

Other  signs:  open  fontanels,  en- 
larged abdomen,  rachitic  rosary, 
enlarged  epiphyses  and  deform- 
ity of  the  long  bones, 

Kyphosis  is  not  frequent  in  infan- 
tile scurvy  and  is  associated  with 
other  joint-lesions,  swollen  gums, 
ecchymoses,  swelling  of  the  epi- 
physeal  junctions  and  pain  on 
moving  legs  and  thighs. 

Kyphosis  occurs  in  elderly  persons 
from  flattening  out  of  the  verte- 
bral discs  from  pressure 

132 


Compression     Myelitis 

DISEASE.  CONCOMITANT  SYMPTOMS. 

SPONDYLITIS  DEFORMANS  (Rheu-  Occurs  late  in  life  with  stiffness 
matoid  arthritis).  and  arching  of  the  spine  without 

kyphosis,  muscular  spasm  and 
suppuration. 

SYPHILIS.  Congenital  and  acquired  syphilis 

by  causing  kyphosis  may  lead 
to  the  erroneous  diagnosis  of 
Pott's  disease,  but  syphilitic  and 
not  tuberculous  symptoms  are 
present. 

COMPRESSION  OF  THE  SPINAL  CORD. 
(COMPRESSION  MYELITIS). 

Spinal  diseases  may,  or  may  not,   be  associated  with 
interruption  of  the  functions  of  the  cord  by  slow  compression. 
Among  the  causes  of  compression  are  the  following : 

1.  Caries  (Pott's  disease). 

2.  Malignant  growths  (vertebral  and  retroperitoneal). 

3.  Aneurisms. 

4.  Syphilis. 

5.  Trauma. 

6.  Parasites  in  the  spinal  canal  (echinococcus  and  the 

cysticercus). 

The  symptoms  of  compression  are : 

i.  VERTEBRAL. — Spinous  processes  tender  on  pressure, 
muscular  rigidity  of  the  spine  and  pain.  The  latter  is 
accentuated  when  the  spine  is  concussed  or  twisted. 

Kyphosis  associated  with  vertebral  disease  is  rarely  the 
cause  of  compression,  for  the  reason  that  the  latter  is  more 
often  the  result  of  inflammation  of  the  spinal  meninges  and 
the  presence  of  inflammatory  products  between  the  involved 
vertebrae  and  meninges.  The  relation  of  the  spinal  cord 
to  the  surrounding  structures  is  shown  in  Fig.  38. 

133 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

2.  NERVE -ROOT  SYMPTOMS. — Caused  by  compression  of 
the  nerve -roots  as  they  emerge  between  the  vertebrae  and 
consist  of  pains  in  the  region  innervated  by  the  nerves  whose 
roots  are  compressed. 

Additional  symptoms  are :  Sensory  and  trophic  disturb- 
ances, herpes;  and  when  the  ventral  roots  are  compressed, 
there  is  wasting  of  the  muscles  supplied  by  the  affected 
nerves. 

3.  CORD -SYMPTOMS.* — They    are    dependent    on    the 
region  involved. 

i.  CERVICAL  REGION. — Retropharyngeal  abscess,  spasm 
of  the  cervical  muscles,  dilatation  of  the  pupils,  unilateral 
sweating  and  flushing  of  the  face  and  paralysis  of  all  four 
extremities. 

ii.  THORACIC  REGION. — Disturbances  of  sensation  in 
the  lower  extremities,  girdle  sensations  and  pains  in  the 
course  of  the  intercostal  nerves  and  paraplegia  (usually 
spastic)  with  exaggerated  reflexes. 

iii.  LUMBAR  REGION. — Paraplegia  without  exaggerated 
reflexes  and  involvement  of  the  bladder  and  rectum. 

PARAPLEGIA. 

This  is  a  symptom  of  many  special  diseases  and  may 
require  a  careful  differentiation.  Following  a  TRAUMA,  it 
occurs  almost  instantly  or  it  may  be  partial  and  in  the  course 
of  a  brief  period  it  may  be  complete  as  a  result  of  a  de- 
structive hemorrhage  or  from  additional  laceration  of  the  cord 
from  a  fractured  vertebra. 

The  paraplegia  associated  with  the  following  affections 
demands  differentiation : 


*The  site  of  the  lesion  is  easily  determined  (page  30). 

134 


Pa        raplegia 

1.  Rickets. 

2.  Barlow's  disease. 

3.  Syphilis. 

4.  Hysteria. 

i.  RICKETS. — The  pseudo-paresis  of  this  disease  results 
from  muscular  weakness  plus  the  pain  caused  by  movements 
of  the  extremities.  The  muscles  may  atrophy  from  disuse, 
but  there  is  no  reaction  of  degeneration.  The  latter  is  also 
absent 'in  cerebral  paralyses  but  the  reflexes  are  exaggerated 
and  there  are  brain-signs  and  spasticity  of  the  extremities. 

ii.  BARLOW'S  DISEASE  (infantile  scurvy). — The  pseudo- 
paralysis  of  this  affection  is  likewise  caused  by  muscular 
weakness  and  pain  as  well  as  by  the  subperiosteal  extravasa- 
tion of  blood  which  causes  tenderness  in  the  shafts  of  the 
bones.  Scurvy  and  rickets  may  co-exist.  In  both  affections 
the  electric  reactions  are  unaltered.  In  scurvy,  antiscorbutic 
treatment  (fresh  cow's  milk,  meat -juice  and  orange-juice  or 
lemon -juice)  yields  prompt  results  and,  in  this  sense,  it  is 
equally  diagnostic  and  curative. 

iii.  SYPHILIS. — In  children  there  is  a  syphilitic  pseudo- 
paralysis  known  as  Parrot's  disease,  in  which  sudden  loss  of 
motion  may  occur  in  either  the  lower  or  upper  extremities 
or  both  and  is  caused  by  a  separation  of  the  cartilage  at  the 
end  of  the  bone.  Crepitation  and  pain  follow  movement  of 
the  affected  extremity. 

iv.  HYSTERIA. — The  disturbances  of  motility  are  essen- 
tially paralyses  of  function  or  will-power. 

In  one  class  of  cases,  movements  like  standing  and 
walking  are  impossible,  whereas  all  other  functions  may  be 
executed  by  the  same  muscles.  The  reflexes  are  intact  or 
exaggerated,  the  electric  reactions  are  normal  and  there  is 
no  muscular  atrophy.  Symptoms  of  the  bladder  common  in 
organic  paraplegia  are  usually  absent  in  the  hysterical  form. 

135 


S  p     o    n    d    y    I    o    the    r    a    p    y 

If  the  affected  muscles  offer  any  resistance  to  passive 
movements,  it  is  suggestive  of  hysteria. 

HOOVER'S  SIGN  for  the  detection  of  malingering  and 
functional  paralysis  of  the  lower  extremities  is  as  follows: 
In  the  norm,  when  a  person  lying  on  a  couch  on  his  back  is 
requested  to  raise  the  right  foot  off  the  couch  with  the  leg 
extended,  the  left  heel  digs  into  the  couch  as  the  right  leg 
and  thigh  are  elevated ;  in  other  words,  the  left  heel  is  used 
to  fix  a  point  of  opposition. 

If  a  normal  person  is  requested  to  press  the  right  leg 
against  the  couch  there  will  be  a  counter -lifting  force  shown 
in  the  left  leg.  This  complemental  opposition  is  present  in 
the  norm  and  in  genuine  paresis  or  paralysis  (even  though 
feebly  expressed)  but  its  absence  in  the  malingerer  and  in 
hysteria  signifies  the  existence  of  cerebral  inhibition. 

The  sign  of  Beevor30  is  based  on  the  fact  that,  in  func- 
tional paralysis  the  patient  is  unable  to  inhibit  the  antago- 
nistic muscles.  This  condition  is  often  noted  in  the  knee  and 
for  this  purpose  the  patient  lies  with  the  face  downward  and 
the  leg  is  put  up  at  right  angles  to  the  thigh  and  the  patient 
is  directed  to  extend  the  knee  against  resistance.  In  the 
norm  the  hamstrings  should  be  relaxed  at  once,  but  in 
functional  paralysis  these  muscles  can  be  seen  and  felt  to 
contract  along  with  the  extensors.  The  limb  must  be  fixed 
and  prevented  from  moving,  otherwise  as  the  joint  is  extended 
or  flexed,  the  antagonists  may  be  passively  drawn  on  and 
give  the  impression  that  their  muscles  are  actively  con- 
tracting. 

Anesthesia  from  the  waist  downward  without  involvement 
of  the  genitalia  is  usual.  The  latter  condition  may  be 
reversed ;  anesthesia  of  the  genitalia,  whereas  the  other  parts 
may  retain  their  sensibility. 

According  to  Kahane,  neuroses  are  favorably  influenced 

136 


Nature      of     Lesion 

by  the  high-frequency  current,  whereas  hysterical  subjects 
react  unfavorably  and  new  symptoms  are  added  to  the  old 
ones  even  after  a  single  application.  In  fact,  latent  hysteria 
has  been  detected  after  this  manner. 

NATURE  OF  THE  LESION. 
TUBERCULOSIS. 

Respecting  the  relative  frequency  of  tuberculous  joint  - 
disease,  the  following  statistics  of  Young31  are  apposite : 

Vertebrae 46.7  per  cent. 

Hip 34.4  " 

Knee 12.2  " 

Ankle 5.1  « 

Elbow 0.8  « 

Shoulder 0.5  " 

Wrist c.3  « 

In  etiology,  a  history  of  heredity  is  important.  Acquired 
predisposition  is  developed  in  consequence  of  conditions 
which  diminish  resistance  and  predisposition  to  tuberculosis. 

Environment  is  a  cogent  predisposing  factor.  The 
absence  of  sunlight  and  fresh  air  predispose  to  infection. 

During  the  first  decade  of  life,  the  bones,  meninges  and 
lymph-glands  are  more  frequently  involved.  A  surgical 
operation  may  convert  a  localized  into  a  generalized  tuber- 
culous process,  notably,  acute  miliary  tuberculosis. 

As  a  rule,  practically  all  tuberculous  joint-lesions  are 
referred  to  some  injury  and  all  authors  agree  that  only  mild 
injuries  result  in  tuberculosis. 

In  severe  traumatism,  the  process  of  repair  is  so  active 
that  the  tubercle  bacilli  are  destroyed.  Experiments  by 
inoculation  confirm  the  latter  clinical  observation.  Thus 
Krause,  after  inoculating  animals  with  tuberculous  material 
and  then  contusing  the  joints,  obtained  typical  joint-lesions. 

137 


Spondylotherapy 

If,  however,  the  traumatism  were  severe  there  was  no  second- 
ary involvement  of  the  joint. 

Tuberculous  involvement  of  the  vertebrae  usually  occurs 
during  childhood  (before  the  age  of  14  years). 

Several  joints  may  be  simultaneously  involved  in  tuber- 
culosis, notably,  the  hip  and  spine  and  the  knee  and  spine. 

Asthenia,  fever,  night-sweats  and  emaciation  are  the 
characteristic  symptoms  of  tuberculous  infection.  The  x- 
rays  may  prove  of  some  value  in  early  diagnosis,  but  as  a 
rule,  the  skiagram  only  demonstrates  lesions  which  have  at- 
tained some  magnitude. 

Respecting  the  diagnosis  of  tuberculous  lesions  by  aid  of 
TUBERCULIN,  the  latter  can  only  prove  of  value  as  a  negative 
test  (showing  the  absence  of  tuberculous  foci  in  the  body) 
and  rarely  as  a  positive  test,  owing  to  the  fact,  that  vertebral 
involvement  is  usually  secondary  to  a  tuberculous  lesion 
elsewhere  in  the  body. 

The  reaction  with  tuberculin  is  based  on  the  fact,  that  in 
tuberculosis  the  tissue-cells  develop  a  hypersensitiveness  to 
the  poisons  of  the  tubercle  bacillus  (oiler gistic  reaction}. 

In  cachectic  individuals,  in  acute  tuberculosis,  and  in  all 
those  far  advanced  in  the  disease,  tuberculin  tests  are  usually 
negative  owing  to  the  fact,  that  the  organism  is  so  over- 
whelmed by  the  poisons  that  it  is  unable  to  react. 

The  tuberculin  test  may  at  first  be  negative,  but  when 
repeated  it  is  positive.  In  such  instances  it  is  assumed,  that 
there  are  latent  tuberculous  foci  which  have  not  been  in 
contact  for  a  long  time  with  the  poisons  of  the  tubercle 
bacillus  and  that  the  first  test  stimulates  immunization  which 
favors  a  reaction  when  the  subsequent  test  is  applied.  A 
positive  reaction  with  the  subcutaneous  method  is  obtained 
in  from  50  to  80  per  cent  of  clinically  healthy  individuals. 

In  the  presence  of  fever,  the  cutaneous  or  conjunctival 

138 


S          y          p          h          i          I          i          s 

method  is  preferable  to  the  original  hypodermic  method.  In 
the  latter  the  puncture -reaction  (red  area  of  infiltration, 
edema  and  pain  at  point  of  puncture)  is  even  more  diagnositc 
that  the  febrile  reaction.  The  MORO  TEST  is  harmless  and 
consists  of  rubbing  into  the  unbroken  skin  of  the  abdomen 
a  mixture  of  equal  parts  of  tuberculin,  (old)  and  anhydrous 
lanolin.  The  rubbing  should  continue  for  about  two  or  three 
minutes.  The  reaction,  if  positive,  is  manifested  in  from  1 2 
to  48  hours  after  the  inunction  by  small  papules  and  redness 
of  the  anointed  area.  The  latter  reaction  is  fairly  reliable. 

The  presence  of  tubercle  bacilli  in  the  circulating  blood 
in  tuberculosis,  demonstrable  after  the  simple  method  of 
Rosenberger,33  may  prove  of  greater  value  in  diagnosis  than 
the  tests  with  tuberculin.  Many  authorities,  however,  have 
been  unable  to  confirm  the  observations  of  Rosenberger. 

Snow,  finds  that  the  employment  of  the  static  current 
gives  prompt  relief  in  non-infected  joint-conditions,  but 
produces  negative  results  or  aggravates  the  condition  in 
tuberculous  infections. 

SCROFULA  is  an  attenuated  tuberculosis  of  the  lymph - 
glands  and  practically  in  all  cases  of  acute  tuberculosis  the 
source  of  infection  is  from  unhealed  foci  in  lymph -glands 
(tuberculous  adenitis). 

SYPHILIS. 

Tardy  hereditary  syphilis  of  the  bones  may  occur  in 
adults,  but  is  most  frequent  between  the  ages  of  6  and  10 
years. 

The  pains  of  this  affection  may  be  regarded  as  rheumatic 
and  the  associated  syphilitic  fever  may  suggest  typhoid  fever. 

The  bones  of  the  extremities  are  notably  involved,  usually 
at  the  shafts  or  in  juxtaposition  to  the  articulations,  and 
swelling  and  deformity  ensue.  The  tibia  is  most  frequently 

139 


S    p     o     n     d    y    I    o     therapy 

implicated,  resulting  in  a  forward  projection  of  the  bone 
(saber-bladed  deformity).  The  surface  of  the  bone  may 
show  irregularity  due  to  the  presence  of  nodes. 

Syphilis  of  the  spine  resembles  Pott's  disease. 

The  following  signs  of  congenital  syphilis  suggest  the 
diagnosis : 

1.  Nasal  catarrh  (snuffles). 

2.  Depression  at  root  of  the  nose. 

3.  Cutaneous  lesions. 

4.  Fissures  at  the  angles  of  mouth  (rhagades). 

5.  Alopecia  (hair  of  head  and  eyebrows). 

6.  Tardy  development  (infantilism). 

7.  Deformed  teeth. 

8.  Interstitial  keratitis. 

9.  Ear-affections. 

The  therapeutic  test  is  fairly  conclusive  if  employed  with 
circumspection.  Here  nutrition  must  be  maintained  to  get 
the  best  results. 

Syphilis  with  lesions  of  the  bones  responds  favorably  to 
Gibbert's  syrup : 

Biniodid  of  mercury i  grain. 

Potassium  iodid \  ounce. 

Water 2  ounces. 

Dose. — Five  to  ten  drops  three  times  a  day  gradually 
increased  and  continued  for  months. 

The  Wassermann  reaction  is  extremely  valuable  in  the 
diagnosis  of  syphilis,  but  the  reaction  is  too  complicated  for 
the  practitioner  and  in  consequence  has  been  supplanted  by 
the  simplified  method  of  Noguchi37:  To  o.i  c.  c.  of  spinal 
fluid  in  a  tube  of  not  over  i  cm.  diameter,  add  0.5  c.  c.  of  10 
per  cent  butyric  acid ;  heat  till  bubbling  and  while  hot  add 
i  c.  c.  of  4  per  cent  sodium  hydrate  solution.  The  fluid  be- 
comes flocculent  in  a  few  moments,  whereas  normal  fluids 
are  only  opalescent  or  cloudy. 

140 


Rheumatism 


GONORRHEA. 

Many  obscure  bone -lesions  incorrectly  diagnosed  as 
rheumatism  owe  their  origin  to  the  gonococcus,  the  result  of 
systemic  gonorrheal  infection. 

Gonorrheal  arthritis  is  characterized  by  involving  joints 
which  are  not  usually  implicated  in  acute  rheumatism,  viz., 
sacro-iliac,  intervertebral,  temporo -maxillary  and  sterno- 
clavicular  articulations. 

A  history  of  gonorrhea  suggests  the  character  of  the  lesion. 

The  employment  of  a  gonococcic  vaccine34  promises  to 
prove  of  diagnostic  value  in  gonococcic  infections.  The 
gonococcus  reaction  usually  appears  in  from  8  to  12  hours 
after  the  injection  and  lasts  about  24  hours.  The  most  con- 
stant feature  of  the  reaction  consists  of  an  increase  of  pain 
and  tenderness  in  the  affected  joints  and  a  slight  pyrexia 
following  the  injection. 

It  is  well  to  recall  the  remarkable  cures  of  gonorrheal 
arthritis  reported  by  Fuller,  who  insists  that  the  infectious 
material  is  derived  from  a  gonorrheal  vesiculitis  and  by 
opening  and  draining  immediate  relief  of  the  arthritis  occurs. 

RHEUMATISM. 

An  acute  arthritis  deformans  may  be  mistaken  for  acute 
rheumatism  and  the  diagnosis  is  often  established  when  the 
affection  has  lasted  for  weeks  and  with  subsidence  of  the 
fever,  periarticular  indurations  and  deformities  persist. 

Implication  of  the  smaller  joints  and  the  early  deformities 
exclude  acute  rheumatism. 

An  acute  osteo -myelitis  may  also  be  confounded  with 
rheumatism,  but  the  following  signs  are  characteristic  of 
osteo-myelitis : 

141 


Spondyloth     e     r    a   p    y 

1.  It  is  most  common  in  infants  or  children,  i.  e.,  during 

the  period  of  active  growth  of  bone. 

2.  Severe  constitutional  symptoms  of  septic  absorption. 

3.  Involvement  of  the  epiphyses  rather  than  the  joints. 

4.  The  condition  is  sudden  in  onset  and  pus  forms 

rapidly. 

5.  In  osteo-myelitis  of  the  vertebrae  angular  deformity 

is  rare  (differentiation  from  Pott's  disease). 

The  use  of  salicylates  is  a  valuable  aid  in  diagnostic 
pharmacotherapy.  Failure  in  the  treatment  of  rheumatism 
with  the  salicylates  frequently  results  from  their  faulty 
administration.  The  usual  doses  are  absolutely  inadequate. 

If  sodium  salicylate  is  given  at  regular  intervals  until  its 
physiologic  action  is  manifested  (tinnitus  or  deafness),  then 
stopping  its  use  and  resuming  it  when  the  latter  have  abated, 
usually  on  the  second  day  there  is  a  decided  fall  of  temper- 
ature and  relief  from  pain  in  acute  rheumatism.  The  joint- 
swelling  usually  disappears  by  the  fourth  day. 

McCrae  and  Clarke  have  directed  attention  to  the  diag- 
nosis of  various  forms  of  arthritis  by  the  use  of  salicylates. 
The  true  rheumatic  can  tolerate  from  150  to  300  grains  of 
sodium  salicylate  before  toxic  symptoms  occur,  whereas  in 
other  forms  of  arthritis  such  symptoms  develop  after  smaller 
doses.  Thus  in  gonococcic  arthritis,  the  average  amount  to 
produce  toxic  symptoms  was  131  grains. 

In  true  rheumatism,  the  fever,  pain  and  swelling  disappear 
in  two  or  three  days,  whereas  in  other  forms  of  arthritis, 
while  the  temperature  may  fall  to  normal,  there  is  no  change 
in  the  swollen  joints.  Doctor  Lees,  in  a  paper  contributed 
to  the  Proceedings  of  the  Royal  Medical  Society,  also  believes, 
that  in  most  instances  where  the  salicylates  fail  to  relieve 
arthritis,  the  condition  is  not  one  of  acute  articular  rheuma- 
tism but  of  some  other  form  of  infection. 

142 


Rheumatism  in  children  is  unattended  by  typical  joint  - 
symptoms  and  a  heart -lesion  may  be  the  only  manifestation 
of  the  disease.  The  following  signs  may  also  suggest  the 
disease  in  children:  tonsillitis  (initial  symptom),  growing 
pains,  chorea,  myalgia,  pleurisy,  frequent  attacks  of  bron- 
chitis and  anaemia.  In  children  the  salicylates  must  likewise 
be  given  in  large  doses:  For  a  child  of  from  7  to  12  years, 
from  10  to  100  grains  daily,  and  for  a  child  under  7  years, 
from  5  to  50  grains  daily,  with  twice  the  amount  of  sodium 
bicarbonate  in  each  case.  The  latter  drug  is  employed  to 
counteract  the  toxic  symptoms  of  the  salicylates.  In  all  cases 
when  the  salicylates  are  given  in  large  doses  one  must  care- 
fully watch  for  the  development  of  drowsiness,  acetone  odor 
•of  the  breath  and  disturbances  of  tke  respiration. 

RICKETS. 

The  associate  symptoms  of  this  affection  are  diagnostic ; 

1.  During  incubation,  local  sweatings  (head  and  neck) 
and  nocturnal  fever  preceding  the  period  of  bone-change. 

2.  Deformation  of  the  bones  is  marked  by  hyperesthesia 
or  tenderness  of  the  latter  and  pain  on  voluntary  movement. 

3.  Deformity  of  the  thorax;  changes  in  the  epiphyseal 
junction  of  the  ribs  (rachitic  rosary,  characterized  by  a  series 
of  bead -like  enlargements) ;  pigeon-breast  or  chicken -breast. 

4.  Deformity  of  the  spine,  exaggeration  of  the  normal 
curves,  scoliosis  and  lordosis,  which  are  accentuated  by  the 
large  size  of  the  abdomen. 

5.  Deformity  of   the  head:     oblong  or  square   head, 
anterior  fontanel  open  (closed  in  the  norm  about  the  i8th 
month);  softened  spots  in  the  occiput  (cranio-tabes),  early 
decay  of  the  teeth  and  retarded  cerebral  development. 

6.  Deformity  of  the  extremities :  an  increase  in  the  size 
of  the  epiphyses  (wrist,  elbow,  ankle,  knee)  which  suggests 

143 


S  p    o    n    d    y    I    o    the    r    a    p    y 

a  joint  (hence  the  popular  expression  "double-jointed")  and 
bending  of  the  long  bones. 

Recovery  may  occur  within  a  few  months,  the  bones 
remaining  thick  and  hard  with  firm  and  short  muscles  and 
partial  disappearance  of  the  deformities. 

SPINAL  MENINGITIS. 

A  chronic  meningitis  may  be  confounded  with  a  tumor 
of  the  spinal  cord  or  disease  of  the  vertebral  column  and 
Horsley35  has  seen  a  number  of  such  cases  which  he  has 
treated  by  laminectomy,  opening  the  theca  and  washing  it 
out  with  a  mercurial  solution. 

The  cases  occur  most  often  in  adults  with  syphilis  or 
gonorrhea  as  possibly  efiologic  factors. 

In  differential  diagnosis  the  following  points  are  of  value : 
A  tumor  of  the  cord  exhibits  pain  usually  localized  to  one 
nerve-root,  but  in  meningitis,  the  pains  spread  gradually  to 
the  front  and  back  of  the  thigh  and  cause  painful  cramping 
and  twitching  of  the  muscles  of  the  right  leg.  Other  signs 
are  tightness  and  numbness  of  the  thigh  and  a  progres- 
sive loss  of  power  in  the  legs  eventuating  in  a  progressive 
paraplegia. 


144 


Abdominal    Supporters 


CHAPTER  V. 

GENERAL  SPONDYLOTHERAPY. 

ABDOMINAL  SUPPORTERS  —  ACUPUNCTURE  —  COUNTERIRRITATION  — 
ELECTROTHERAPY — EXERCISES — RE-EDUCATION  OF  CO-ORDINATED 
MOVEMENTS — SPINAL  HYDRO-THERAPY — LUMBAR  PUNCTURE  — 
MASSAGE  —  PStfCHROTHERAPY  —  THERMOTHERAPY  —  VIBRATORY 
MASSAGE. 

ABDOMINAL  SUPPORTERS. 

Reduced  intra-abdommal  tension  conduces  to  a  condition 
described  by  the  author  as  intra-abdominal  insufficiency,  and 
the  latter  contributes  to  a  group  of  symptoms  made  up  of 
backache  and  neurasthenia. 

Minor  grades  of  insufficiency  may  be  detected  by  the 
following  signs,  which  the  writer  has  described  more  fully 
elsewhere:38  first,  auscultate  the  heart -tones,  palpate  the 
pulse,  determine  blood -pressure  and  define  by  percussion  the 
borders  of  the  heart  and  the  upper  border  of  the  liver  while 
the  patient  is  standing.  Next,  direct  an  assistant  standing 
behind  the  patient  to  firmly  and  forcibly  lift  the  abdomen, 
exerting  the  pressure  in  a  direction  upward  and  inward. 
While  the  latter  pressure  is  maintained,  the  foregoing  methods 
of  examination  are  again  executed  and  if  abdominal  tension 
is  reduced  the  following  are  noted :  the  heart-tones  become 
stronger,  the  pulse  fuller,  the  blood -pressure  augmented  from 
5  to  30  mm.  and  the  percussion  areas  of  the  heart  and  liver 
become  higher  and  more  pronounced. 

The  heart  is  prolapsed  (cardioptosis)  as  well  as  the  liver 
in  diminished  abdominal  tension. 

The  author  has  frequently  noted  a  systolic  aortic  murmur 
when  the  abdomen  was  pendulous  which  disappeared  during 

145 


S  p     o    n     d    y    I    o    the    r    a    p    y 

the  time  the  abdomen  was  raised  by  an  assistant  and  re- 
appeared when  the  abdominal  wall  was  dropped.  This 
murmur  is  probably  caused  by  traction  on  the  aorta 
by  a  prolapsed  heart,  the  result  of  an  intra-abdominal 
insufficiency. 

Many  of  the  local  symptoms  of  reduced  abdominal  tension 
are  at  once  relieved  by  raising  the  abdomen  in  the  manner 
suggested  and  if  an  abdominal  support  is  employed,  its  value 
may  be  tested  by  noting  the  effects  on  the  pulse,  blood - 
pressure  and  position  of  the  heart  before  and  after  its 
application. 

Those  who  object  to  mechanic  supports  will  find  in  the 
method  of  Kellogg,  an  excellent  means  of  strengthening  the 
abdominal  muscles  and  thus  securing  a  natural  increase  of 
intra-abdominal  tension;  the  electrodes  of  a  sinusoidal  cur- 
rent are  placed  on  either  side  of  the  spine  about  four  inches 
apart  and  just  below  the  inferior  angles  of  the  scapulae. 
When  the  current  is  sufficiently  strong,  all  the  abdominal 
muscles  will  be  thrown  into  vigorous  contraction. 

ACUPUNCTURE. 

The  author  has  already  portrayed  his  conception  of  many 
diseases  as  expressed  in  the  antagonism  of  muscles  (page 
n).  This  theory  is  in  accord  with  our  percutaneous 
methods  of  treatment  and  refers  with  special  cogency  to 
spondylotherapy.  In  the  foregoing  pages  the  following  fact 
has  been  elaborated,  viz.,  that  throughout  the  spinal  region 
one  may  arouse  definite  reflexes  and  that  every  reflex  has  its 
counter-reflex.  Thus  our  therapy  by  peripheral  methods 
resolves  itself  into  the  following:  either  an  abnormal 
reflex  is  inhibited  or  it  may  be  antagonized  by  a  counter- 
reflex.  In  a  word,  peripheral  stimulation  signifies  irritation 
of  centrifugal  or  centripetal  nerves.  In  arousing  the  former 

146 


Acupuncture 

to  activity  we  stimulate  motor,  secretory,  trophic,  inhibitory 
and  thermic  nerves,  whereas  stimulation  of  the  centripetal 
nerves  predicates  an.  action  on  the  reflex -motor,  reflex- 
secretory  and  reflex -inhibitory  nerves.* 

Lumbago  (myalgia  lumbalis),  may  be  confounded  with 
many  reflex  troubles  and  affections  of  the  vertebral  column. 
If  the  lumbar  pains  originate  in  the  muscles  alone,  acupunc- 
ture, by  its  almost  miraculous  curative  action,  is  diagnostic 
of  lumbago. 

The  method  may  be  made  painless  by  local  anesthesia 
before  ordinary  sterilized  bonnet -needles  are  forced  into  the 
painful  points  of  the  lumbar  muscles  and  allowed  to  remain 
for  about  ten  minutes.  It  may  be  necessary  to  repeat  the 
manceuver.  A  number  of  smaller  needles  may  be  passed 
through  the  skin  into  the  muscular  tissue.  The  method  is 
equally  efficacious  in  the  treatment  of  myalgias  elsewhere 
and  appears  to  be  more  successful  in  those  who  have  bilateral 
pain. 

Sir  James  Grant  supposes  that  the  needles  set  free  an 
excessive  storage  of  electricity  which  has  accumulated  in  the 
muscles. 

An  intramuscular  injection  of  morphine  (1-6  grain)  and- 
atropin  (1-60  grain),  or  a  few  minims  of  chloroform,  may  also 
give  immediate  relief,  but  here  it  is  difficult  to  differentiate 
the  action  of  the  medicament  and  the  acupuncture. 

*The  excitability  of  certain  nerve-centers  is  diminished  by  calling  other  centers  into 
action.  Franck,  in  the  "Dictionnaire  Encyclopedique  des  Sciences  Medicales" 
observes,  that  when  one  considers  the  normal  functions  of  the  nervous  system, 
one  finds  that  there  exists  a  necessary  equilibrium  between  the  different  parts 
of  this  system.  This  equilibrium  may  be  destroyed  by  the  abnormal  pre- 
dominance of  certain  centers  which  seem  to  divert  to  their  own  advantage  too 
great  a  proportion  of  the  nervous  activity;  thus,  the  functions  of  the  other 
centers  appear  to  be  disturbed.  The  ankle-clonus  depends  on  an  exaggerated 
excitability  of  the  calf  muscles.  If  now,  I  excite  with  the  sinusoidal  current 
the  spinal  segment  (page  30)  presiding  over  the  muscles  which  antagonize 
the  calf  muscles,  for  a  time,  at  least,  the  ankle-clonus  can  no  longer  be  elicited. 
This  method  has  been  employed  successfully  by  the  author  in  overcoming 
spasms  of  definite  groups  of  muscles. 

147 


S  p 


o     n 


d 


t    h 


r    a    p   y 


COUNTERIRRITATION. 


Counterirritants  are  valuable  agents  for  the  relief  of  pain 
if  applied  in  correct  situations.  As  we  will  notice  in  the 
subsequent  chapter  on  PSEUDOVISCERAL  DISEASES,  the  pains 
usually  experienced  in  the  thoracic  and  abdominal  walls  are 


Phthisis. 
Pericarditis    or    pleurisy. 

Flying  blister  or  sina- 
pism, in  pleurisy  or 
pneumonia. 

Vomiting. 


Chronic  thickening 
after  perityphlitis. 


Acute  rheumatism^ 


Laryngitis,  hysteric 
aphonia. 

Pericarditis. 


Ovarian  irritation. 


Gout. 


FlG.  40. — Diagram  of  the  body  showing  some  of  the  areas  where  counterirritants 
are  usually  applied.    Front  view. 

pains  referred  to  the  periphery,  whereas  the  actual  site  of  the 
lesion  is  alongside  of  the  spine  at  the  vertebral  exits  of  the 
affected  nerves.  It  is  evident  then,  that  if  the  counter- 
irritant  is  applied  at  the  point  where  the  pain  is  felt  rather 
than  at  the  site  of  the  lesion,  no  result  is  achieved.  It  was 
the  custom  of  Trousseau  to  trace  a  neuralgia  along  the  course 

148 


Co    u    n    t'-tr  irritation 


of  a  nerve  to  the  spine  from  which  it  made  its  exit,  at  which 
site  the  painful  point  was  blistered. 

In  diseases  of  the  hip,  pain  is  felt  in  the  knee,  yet  the 


Epistaxis,  cerebral  con- 
gestion, 'delirium,  and 
tendency  to  coma,  or 
constant  .  wakefulness, 
in  fever,  headache,  gid- 
diness, tinnitus  au- 
rium. 

Hemoptysis. 

Intercostal  neuralgia. 


Rheumatic  gou 


Headache,  giddiness,  tin- 
nitus aurium,  ophthal- 
mia. 


Flying  blister  or  sina- 
pism, in  pleurisy  or 
pneumonia. 

Dysmenorrhea,  spinal  ir- 
ritation, leucorrhea. 


Sciatica. 


Sciatica. 


FIG.    41. — Diagram  of  the  body  showing  some  of  the  areas  where  counter- 
irritants  are  usually  applied.     Back  view. 

counterirri  tantj  to  be  effective,  must  be  applied  to  the  hip. 
Insomuch  as  counterirritants  achieve  their  analgesic 
effects  by  influencing  the  distribution  of  blood  in  a  part  either 
reflexly  through  changes  in  the  caliber  of  the  vessels  or  by 
anemizing  the  morbid  structures,  leeching  and  cupping  may, 
in  many  instances,  achieve  like  effects.  It  may  be  necessary 
in  some  instances  to  accentuate  counterirritation  and  for 
this  purpose  an  escharotic  or  :he  actual  cautery  is  used. 

149 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

The  observation  of  Head  (page  58)  shows  that  the  vis- 
cera and  definite  areas  on  the  surface  of  the  body  receive  their 
nerve -supply  from  the  same  segment  of  the  spinal  cord  and 
that  irritation  of  the  one  reacts  favorably  upon  the  other. 

It  will  be  noted  in  the  accompanying  figures  (40  and  41 ) 
from  Brunton,  that  the  areas  established  empirically  for 
applying  counterirritants  to  influence  the  viscera  nearly 
correspond  to  the  dermatomes  of  Head. 

Nothing  in  my  experience  equals  freezing  (vide  psychro- 
therapy)  for  the  purpose  of  counterirritation  in  spondylo- 
therapy  and  for  this  reason,  I  employ  freezing  to  the  exclusion 
of  all  other  methods. 

Cantharides  is  the  usual  vesicant  employed,  although 
many  preparations  on  the  market  are  useless.  Before  apply- 
ing cantharidal  collodin  or  a  plaster,  wash  with  soap  and 
water  and  then  dry  the  skin  thoroughly  with  alcohol  and  if  a 
plaster  is  used,  moisten  it  with  a  few  drops  of  acetic  acid. 
Vesication  occurs  in  about  eight  hours.  At  the  end  of  that 
time,  carefully  remove  the  plaster  to  avoid  rupturing  the 
bleb  and  puncture  the  latter  at  its  most  dependent  part  with 
an  antiseptic  needle  and  dress  with  dry  absorbent  cotton. 
After  the  latter  fashion  the  skin  rapidly  forms  under  the 
blister.  If  the  latter  is  broken,  sprinkle  the  surface  with 
orihoform,  which  renders  the  healing  painless. 

Cantharides  is  readily  absorbed  from  the  skin  and  toxic 
symptoms  (strangury,  priapism  and  nephritis)  may  follow, 
hence  blistering  must  be  achieved  with  other  drugs. 

Methyl  iodid  has  no  unpleasant  action  on  the  urinary 
organs.  About  15  to  30  drops  of  the  liquid  is  poured  on  a 
piece  of  blotting  paper  which  has  been  cut  to  the  desired 
size  and  then  fastened  to  the  cleansed  skin  by  adhesive 
plaster.  Blisters  appear  in  from  3  to  18  hours. 

A  blister  may  be  produced  in  several  minutes  by  saturat- 

150 


Electro     t     h     e     r     a    p     y 

ing  a  piece  of  lint  with  chloroform  and  after  its  application 
covering  it  with  oiled-silk  or  a  watch-glass. 

Equal  parts  of  lard  and  ammonia  will  blister  in  about 
five  minutes. 

ELECTROTHERAPY.* 

It  is  yet  customary  to  regard  the  results  obtained  from 
electric  treatment  as  dependent  on  suggestion.  Mcebius 
tells  us  that  four-fifths  of  all  electric  cures  are  dependent  on 
mental  influence.  Even  Beard,  who,  in  his  time,  was  one 
of  the  leaders  in  electrotherapeutics,  is  quoted  by  Kellogg 
as  saying :  "If  you  expect  to  get  definite  results  from  electrical 
applications,  you  must  be  sure  that  your  patient  has  faith, 
otherwise  the  application  will  do  him  no  good." 

Electrotherapy  is  now  founded  on  a  scientific  and,  what 
is  more  important,  a  utilitarian  basis.  All  currents  do  not 
show  the  same  physiologic  and  therapeutic  effects  any  more 
than  do  the  various  alkaloids  derived  from  opium,  although 
the  same  plant  is  the  common  source  of  all.  The  discovery 
of  the  SINUSOIDAL  CURRENT  is  accredited  to  D'Arsonval, 
although  Kellogg's  description  of  the  current  in  1888,  pre- 
ceded the  publication  of  the  former. 

The  sinusoidal  current  does  not  produce  the  unpleasant 
and  painful  effects  of  the  Faradic  current  and  is  decidedly 
more  effective  for  the  average  therapeutic  purpose  than  is 
the  Galvanic  current.  The  Faradic  current  is  alternating 
in  character  in  which  the  break  in  the  direction  of  the  current 
occurs  at  the  maximum  point  of  intensity.  The  Galvanic 
current  is  continuous  and  any  change  in  the  direction  or  in 
the  interruption  of  the  current  is  a  sudden  break  associated 
with  a  painful  shock. 

*Only  the  sinusoidal  current  will  be  described,  as  it  is  used  by  the  author  almost 
exclusively  in  the  diagnosis  and  treatment  of  spinal  diseases. 

151 


S   p     ondyloth     e     r    a    p    y 

The  preceding  conditions  with  the  sinusoidal  current  do 
not  exist.  It  is  probable  that  the  rapidity  of  alternations  is 
so  great  that  the  sensory  nerves  fail  to  appreciate  the  im- 
pressions of  such  high  frequency.  The  current  gradually 
rises  from  the  base  line,  zero,  to  the  maximum,  then  equally 
gradually  returns  to  zero,  then  likewise  rises  to  the  maximum 
in  the  opposite  direction,  and  returning  to  zero  repeats  the 
rhythm  at  the  rate  of  many  thousand  alternations  per  minute 
(Fig.  42). 


FIG.  42. — A  true  sine  curve  from  which  the  sinusoidal  current  obtains  its 
name.  The  length  of  the  sine  being  from  points  i  to  2,  which  is  one  complete 
cycle  and  two  complete  alternations.  In  what  is  called  the  60  cycle  current,  which 
goes  through  this  change  sixty  times  per  second,  this  distance  from  i  to  2  repre- 
sents one-sixtieth  of  a  second  and  in  the  125  cycle  variety,  1-125  °f  a  second. 
These  currents  are  sometimes  spoken  of  as  having  7,200  and  15,000  respectively* 
alternations  per  minute,  since  there  are,  of  course,  two  alternations  (one  each 
way)  in  each  cycle  and  60  seconds  in  a  minute.  The  distance  of  this  curve  above 
or  below  the  horizontal  neutral  line  represents  at  each  instant  the  potential  or 
degree  of  polarity  at  that  point,  the  points  above  the  line  being  positive  and  those 
below  negative,  and  this  degree  of  polarity  determines  the  strength  of  the  current 
at  that  instant  and  the  direction  of  its  flow. 

Many  of  the  sinusoidal  apparatuses  on  the  market  are 
such  in  name  only  and  do  not  achieve  the  results  cited  in 
this  work. 

With  the  original  Kenelly  machine,  one  could  obtain  a 
frequency  up  to  150,000  alternations  per  minute.  The 
latter  machine  is,  however,  too  expensive  for  general  use  and 
with  less  costly  apparatus  equally  efficient  results  can  be 
attained. 

The  author's  (Fig.  43  )  apparatus  is  simple  in  construction 

152 


E    I 


troth 


r     a    p    y 


and  has,  therefore,  few  of  the  faults  of  more  complicated 
machines. 

By  screwing  the  plug  attached  to  the  cord  into  a  lamp- 
socket,  it  is  ready  for  use.    The  number  of  alternations  is 


FIG.  43. — The  author's  sinusoidal  apparatus. 

determined  by  a  rheostat  and  varies  from  2,000  to  20,000  per 
minute.  It  is  especially  constructed  for  the  direct  street - 
current,  although  it  can  be  made  available  for  the  alternating 
current.  With  an  alternating  current -supply  only,  the  value 

153 


Spondyloth 


a    p    y 


of  the  current  obtained  is  very  much  restricted.    The  Galvanic 
current  may  also  be  obtained  from  the  same  apparatus. 

Doctor  J.  H.  Kellogg's  sinusoidal  apparatus*  (Fig.  44) 
embodies  Kellogg's  discoveries  and  is  a  very  efficient  appara- 
tus for  obtaining  sinusoidal  effects.  It  is  provided  with  a 
finely  graduated  rheostat,  by  means  of  which  the  powerful 


FIG.  44. — Sinusoidal  apparatus  of  Dr.  J.  H.  Kellogg. 

currents  generated  may  be  reduced  to  the  smallest  require- 
ment. It  consists  essentially  of  a  specially  constructed 
magneto -generator  operated  with  an  electric  motor.  A 
slowly  alternating  current  designated  as  SS  (slow  sinusoidal), 
is  usually  employed  for  muscular  effects,  and  the  rapidly 
alternated  current  RS  (rapid  sinusoidal),  is  used  to  induce 
powerful  tonic  contractions  and  to  secure  analgesic  action  or 
other  nerve-effects. 

Another  efficient  apparatus  (Fig.  45)  for  sinusoidal 
purposes  is  the  outfit  made  by  the  Victor  Electric  Company 
of  Chicago.  In  the  multiplex  outfit  of  the  latter  company 
one  can  adequately  control  the  length  of  the  sine  wave  and 
the  voltage  as  well.  The  apparatus  can  be  attached  to  any 

*Made  by  the  Modern  Medicine  Company,  Battle  Creek,  Michigan. 

154 


E    I 


r     o 


a    p    y 


electric -light  socket  and  it  is  calculated  for  the  direct  current. 
It  is  also  supplied  for  connection  to  the  alternating  current, 
but  when  employed  in  this  way  its  value  is  very  much 
restricted. 

When  the  Victor  apparatus  is  employed  for  eliciting  the 
vertebral  reflexes,  the  author  suggests  only  the  employment 
of  the  rapid  sinusoidal  current. 


FIG.  45. — Sinusoidal  apparatus  made  by  the  Victor  Electric  Company. 

DIAGNOSTIC  AND  THERAPEUTIC  APPLICATION 
OF  THE  SINUSOIDAL  CURRENT. 

This  subject  will  be  discussed  in  detail  in  special  chapters 
devoted  to  visceral  diseases.  One  of  the  most  important 
properties  possessed  by  this  current  by  its  cutaneous  appli- 
cation alone,  is  the  powerful  and  demonstrable  action  on  the 
internal  organs.  Thus,  with  one  electrode  at  an  indifferent 
point  (the  author  prefers  the  sacral  region),  and  the  other 
over  the  regions  of  the  various  organs,  visceral  reflexes  may 

1S5 


Spondyloth 


r    a   p    y 


be  elicited.  If  both  electrodes  are  applied  to  the  abdomen 
it  reduces  intra -abdominal  congestion. 

By  aid  of  this  current,  as  will  be  demonstrated  later, 
toxic  intestinal  and  hepatic  products  are  brought  to  resorption 
and  excreted  in  the  urine. 

The  various  vertebral  reflexes  (page  7)  can  be  elicited 
by  this  current,  but  for  therapeutic  purposes,  concussion 
(page  175)  often  exceeds  it  in  value. 

The  current  has  a  specific  action  in  hyperesthetic  con- 
ditions whether  superficial  or  deep-seated,  and  is  of  all 


FlG.  46. — Interrupting  electrodes. 

currents  the  most  available  for  inducing  analgesic  effects. 

It  is  very  often  the  most  efficient  current  for  developing 
weakened  muscles  and  not  infrequently  it  will  provoke 
muscular  contractions  in  degenerative  lesions  when  Faradism 
produces  no  response. 

In  applying  this  current  for  diagnostic  and  even  for 
therapeutic  purposes  the  moistened  indifferent  pad  (usually 
large)  is  placed  over  the  sacrum,  whereas  the  interrupting 
electrode  (Fig.  46),  which  permits  one  to  close  and  open 
the  circuit,  is  placed  over  specific  regions. 

To  induce  muscular  contractions  it  is  not  necessary,  as  in 
the  use  of  other  currents,  to  find  the  motor  points  (points  of 
greatest  excitability).  To  obtain  the  maximum  contraction 
of  the  muscles  of  the  back,  the  latter  must  be  relaxed. 

156 


E    I 


t     h 


a    p    y 


To  excite  the  muscles  of  the  back  for  diagnostic  or  develop- 
mental purposes  strong  currents  must  be  used.  Referring 
to  Fig.  47,  the  effects  of  a  strong  sinusoidal  current  are  noted 


FIG.  47. — Muscles  of  the  back  showing  Triangle  of  Petit  (shaded  triangular 
area).  The  trapezius  retracts  the  scapula  and  braces  back  the  shoulder;  when 
the  head  is  fixed,  the  upper  part  of  the  muscle  will  elevate  the  point  of  the  shoulder 
(electromotor  point,  E.M.P.,  A),  whereas  the  lower  fibres  depress  the  scapula 
(E.M.P.,  B) ;  with  fixed  shoulders,  action  of  one  trapezius  will  draw  the  head  to 
the  corresponding  side  (E.M.P.,  C).  The  latissimus  dor  si  when  the  arms  are 
fixed  raise  the  lower  ribs  and  assist  in  forcible  inspiration  (E.M.P.,  D).  Application 
of  the  electrode  at  any  of  the  points  marked  E,  E,  E,  will  accentuate  the  lordosis 
in  the  lumbar  region  and,  at  F,  on  the  right  side,  scoliosis  is  produced  to  the  left 
side,  and,  at  a  corresponding  point  on  the  left  side,  scoliosis  to  the  right  side.  By 
marking  the  tips  of  the  spinous  processes  or  by  noting  the  spinal  furrow,  the  scoliotic 
changes  are  best  observed.  G,  electromotor  point  which  causes  an  approximation 
of  the  scapula  to  the  spine. 

when  one  pole  is  applied  over  the  sacrum  and  the  interrupting 
electrode  is  placed  at  various  points  indicated  by  circles. 
The  effects  of  this  current  can  be  more  easily  demonstrated 

157 


S   p    o     ndylotherapy 

if  the  spinous  processes  are  marked  with  a  pencil,  thus  indi- 
cating any  deviation  of  the  vertebral  column.  Changes  in 
the  curvature  of  the  spine  are  naturally  less  evident  in  adults 
than  in  children. 

This  current  is  specially  indicated  when  the  development 
and  strengthening  of  the  spinal  muscles  are  the  objects  in 
view.  Here  the  electrodes  must  be  placed  at  corresponding 
points  on  either  side  of  the  spine  so  that  the  muscles  on  one 
side  should  not  exceed  in  development  or  strength  the  muscles 
on  the  other  side.  By  inducing  the  central  reflexes  (page 
n),  a  symmetrical  development  is  easily  achieved. 

A  backache  is  very  frequently  a  weak  back ;  the  muscular 
tire  graduating  into  pain  and  here  the  remedy  is  muscular 
development. 

It  is  difficult  to  devise  any  exercises  which  will  bring  into 
action  the  thirty-one  muscles  of  the  back  which  are  sub- 
divided into  five  layers. 

Not  infrequently,  the  so-called  uric-acid  diathesis  is  a 
localized  intoxication ;  the  unused  muscles  favoring  the  pre- 
cipitation of  uric -acid  or  other  products  of  defective  meta- 
bolism and  creating  what  is  popularly  called  "stiff-back." 
To  destroy  such  products,  it  is  necessary  to  bring  a  greater 
supply  of  blood  to  the  parts,  for  more  circulating  blood  means 
more  oxygen  and  more  oxygen  means  better  nutrition. 
Sinusoidalization  of  the  muscles  of  the  back  is  more  efficient 
than  any  exercises.  The  author  has  investigated  the  output 
of  urea  before  and  after  sinusoidalization  of  the  muscles  of 
the  back  in  many  cases  of  backache  and  noted  the  pertinent 
fact  that,  as  a  rule,  there  was  an  augmented  excretion  of  urea 
after  sinusoidalization.  Voit  has  shown  that  work  does  not 
increase  the  elimination  of  nitrogen  by  the  urine,  hence  the 
increased  output  in  my  cases  was  due  to  the  removal  of  urea 
stored  up  in  the  muscles. 

158 


Exercises 

It  is  evident  to  the  reader  that  in  the  event  muscular 
rigidity  is  present,  muscular  contraction  is  less  readily  elicited 
by  the  current  than  when  the  muscles  are  relaxed,  hence  in 
this  respect,  the  current  subserves  a  diagnostic  use. 

EXERCISES. 

About  one -half  of  the  body -weight  is  dependent  on  the 
muscular  system  which,  even  in  a  state  of  rest,  holds  about 
one-quarter  of  the  total  quantity  of  blood  When  the  muscles 
are  in  activity  the  amount  of  blood  which  they  hold  is  very 
much  augmented. 

Muscular  exercises  subserve  the  following  objects : 

1.  They  increase  the  frequency  and  amplitude  of  the 

respiratory  movements. 

2.  By  increasing  pulmonary  capacity  they  aid  the  work 

of  the  right  heart. 

3.  By  determining  an  increased  quantity  of  blood  to 

the  muscles*  certain  congested  areas  are  depleted.f 

4.  Waste-products  are  increased  in  the  blood  and  there 

is  augmented  excretory  activity  of  the  kidneys, 
skin  and  lungs. 

In  prescribing  exercises,  one  must  never  forget  their  bane- 
ful effects  on  the  nervous  system  when  carried  to  excess. 

When  a  muscle  is  fatigued  by  voluntary  contraction,  it 
involves  not  only  the  muscle  but  the  nervous  system,  and  the 
latter  to  a  larger  degree  than  the  former.  It  is  erroneous  to 
suppose  that  a  healthy  nervous  system  can  be  acquired  by 
vigorous  muscular  exercises.  The  latter  always  means  an 
expenditure  of  nerve -force  which  may,  or  may  not,  be  beyond 

*Oliver  has  shown  that  the  relative  quantity  of  the  corpuscles  is  increased  in  the 

blood  of  an  exercised  limb. 
tThe  same  author  has  demonstrated  that  while,  after  a  period  of  rest,  a  relatively 

large  amount  of  blood  can  be  expressed  from  the  abdomen  into  the  systemic 

vessels,    no   such   result   can   be   attained   by   abdominal   compression   after 

exercises. 

159 


S    p     ondylotherapy 

the  capacity  of  the  individual.     Many  nervous  wrecks  are 
recruited  from  this  fallacious  argument. 

Spinal  exercises  achieve  the  following  objects : 

1.  Increased  flexibility  of  the  spine. 

2.  Strengthening  the    muscles  which  hold  the  trunk 

erect. 

3.  Combating  a  faulty  attitude. 

Supports  and  plaster-jackets  in  the  treatment  of  curva- 
tures are  only  indicated  in  acute  inflammatory  affections  of 
the  bone.  Otherwise  they  conduce  to  ankylosis  in  a  deformed 
position  with  muscular  atrophy  from  disuse. 

Impaired  mobility  of  the  spine  is  frequently  the  cause  of 
distressing  backaches,  sciaticas  and  other  affections.  Here 
passive  movements  of  the  spine  are  often  curative.  The 
patient  sits  on  the  bed  and  the  physician  can  repeatedly  force 
the  body  forward  or  he  can  execute  any  degree  of  traction 
on  the  arms. 

Exercises  for  the  muscles  of  the  back  are  most  often 
prescribed  in  the  treatment  of  round  shoulders  and  lateral 
curvature. 

ROUND  SHOULDERS.* 

This  condition  is  more  frequently  encountered  in  girls 
than  in  boys,  owing  to  the  fact  that  in  the  adjustment  of 
clothes  there  is  a  drag  upon  the  shoulders  equal  to  several 
pounds  on  either  side.  Here,  as  Goldthwait  suggests,  the 
weight  must  be  removed  from  the  outer  part  to  the  inner  or 
rigid  part  of  the  shoulder  at  the  base  of  the  neck.  The 
patient  should  be  taught  to  assume  a  correct  position,  chest- 
deformities  must  be  corrected  by  breathing,  gymnastics,  and 
the  following  exercises  recommended  by  Lovett  are  indicated : 

*Vide  page  96. 

160 


E 


X 


1.  The  patient  hangs  from  a  bar  by  the  arms. 

2.  In  the  recumbent  position,  with  a  hard  roll  under 

the  scapulae,  the  arms  are  extended  and  stretched 
and  pulled  above  the  head  upwards  and  back- 
wards by  an  assistant. 

3.  The  patient  sits  on  a  stool  with  the  hands  behind  the 

head  and  the  elbows  squared;  during  the  time  the 
elbows  are  pulled  backwards,  the  knee  of  the 
manipulator  presses  forward  against  the  spine  on 
a  level  with  the  shoulders. 

LATERAL  CURVATURE. 

Here  muscular  exercises  constitute  the  essential  part  of 
the  treatment.  At  least  one  hour  daily  must  be  devoted  to 
their  execution,  and  as  Robert  Jones  suggests,  the  arms 
should  always  be  moved  by  direct  muscular  effort  and  not 
allowed  to  swing. 

Ridlon49  employs  the  following  exercises: 

1.  The  patient  lies  upon  her  back  upon  a  table  of  con- 

venient height,  width  and  length.  The  Swedish 
table  known  as  the  plinth  is  perhaps  the  most  con- 
venient. With  her  arms  at  the  sides  of  her  body, 
and  the  palms  upwards,  she  breathes  slowly  and 
deeply  ten  times.  In  patients  who  present  a  pro- 
jection of  the  ribs  below  the  breast,  it  is  of  advan- 
tage for  the  surgeon  to  make  pressure  downwards 
with  his  hands  upon  these  projecting  ribs  as  the 
patient  takes  a  full  breath. 

2.  The  patient  grasps  a  bar  of  steel  shafting  3-4  ft.  in 

length  and  10-20  Ibs.  in  weight.  With  the  elbows 
straight,  she  swings  this  from  the  thighs  forwards 
and  upwards  above  the  head  until  the  bar  reaches 
the  level  of  the  table.  From  here  she  swings  it 
downwards  again  to  the  thighs,  and  this  is  repeat- 
ed ten  times. 

161 


S    p     ondylotherapy 

3.  The  arms  are  then  stretched  directly  outwards  from 

the  sides  of  the  body,  and  in  this  position,  as  in  (i), 
she  breathes  deeply  ten  times  while  the  projecting 
ribs  are  held  down  by  the  surgeon. 

4.  Again,  the  iron  bar  is  swung  from  the  thighs  to  the 

table  above  the  head  and  back  ten  times. 

5.  Then  the  arms  are  stretched  upwards  by  the  side  of 

the  head  to  the  fullest  reach,  care  being  taken  that 
the  lower  shoulder  is  raised  as  far  as  the  other. 
The  arms  are  held  in  this  position,  and  the  patient 
breathes  deeply  ten  times,  the  ribs  again  being 
held  down. 

6.  Then  an  iron  bar  of  the  same  length,  but  double  the 

weight  of  the  former,  is  placed  in  the  patient's 
hands  as  she  lies  upon  her  back,  and  she  raises  it 
directly  upwards  from  the  chest,  fully  straighten- 
ing the  arms,  and  repeats  the  exercise  ten  times. 

7.  Still  lying  on  the  back,  with  the  knee  held  straight 

and  rigid  and  the  foot  extended,  the  patient  circles 
the  limb  from  the  hip-joint,  making  as  large  a 
circle  as  possible  with  the  foot  ten  times.  Then 
the  other  limb  is  circled  in  the  opposite  direction 
ten  times. 

8.  Still  lying  on  her  back  with  hands  grasping  the  top 

of  the  table,  both  limbs  are  lifted,  while  the  knees 
are  held  straight  and  the  feet  extended  upwards 
to  the  fullest  point,  if  possible  to  the  vertical 
position,  and  repeated  five  times. 

9.  The  patient  then  turns  on  her  face,  is  pushed  out  so 

that  the  body  extends  beyond  the  end  of  the  table 
by  the  surgeon,  and  she,  holding  the  head  and 
shoulders  as  high  as  possible,  makes  with  her 
arms  the  motion  of  swimming,  the  forward  stroke 
of  which  should  be  particularly  vigorous.  In  this 
position  ten  strokes  are  taken. 

162 


E       x 


10.  The  patient  is  then  pulled  back  upon  the  table,  and 

lying  face  downward  with  the  knee  straight  and 
the  foot  extended,  she  circles  first  one  leg  and 
then  the  other,  making  the  largest  possible  circle 
with  the  foot,  ten  times. 

11.  The  patient  is  again  pushed  out  with  the  body 

beyond  the  end  of  the  table,  and  with  the  arms  in 
the  key-note  position,  she  bends  the  body  down- 
wards and  raises  it  upwards  as  far  as  possible. 
This  is  repeated  five  times. 

The  key-note  position  consists  of  such  a  position  of  the 
arms  as  places  the  back  in  the  straightest  line. 
For  an  ordinary  dorsal  curvature  with  a  convexity 
to  the  right,  the  key-note  position  consists  of 
pushing  the  left  arm  as  far  as  possible  up  beside 
the  head  and  holding  it  there  close  to  the  ear, 
while  the  right  arm  is  stretched  directly  outwards 
with  the  palm  turned  upwards;  but  the  key-note 
position  must  be  determined  for  each  particular 
case. 

12.  With  the  patient  again  pulled  back  and  lying  com- 

fortably upon  the  table,  she  takes  a  5-lb.  dumb- 
bell in  each  hand,  and  swings  them  outwards  and 
upwards,  that  is,  backwards,  as  far  as  possible, 
ten  times. 

13.  The  patient,  still  lying  on  her  face  on  the  table, 

places  her  arm  in  the  key-note  position;  then  as 
she  counts  aloud  one,  two,  the  legs  are  held  down, 
she  raises  the  head  and  shoulders  upwards  and 
backwards  as  far  as  possible;  then,  counting 
three,  four,  she  bends  the  head  and  shoulders  as 
far  as  possible  towards  the  convexity  of  the  curva- 
ture; then  counting  five,  six,  she  twists  the  head 
and  shoulders  around  towards  the  side  of  the 
convexity,  as  if  in  an  effort  to  look  over  the 
shoulder;  then,  counting  seven,  eight,  she  swings 
and  turns  back  into  the  straight  position  from 
which  she  started,  and  this  exercise  is  repeated 
five  times. 

163 


S   p    o     n    d    y     I    o     t    h     e     r    a    p    y 

14.  The  patient  then  sits  astride  the  narrow  end  of  the 

table,  while  the  surgeon  sits  astride  the  table 
behind  her,  steadying  her  hips  with  his  knees. 
Then,  with  arms  in  the  key-note  position  and  the 
spine  as  straight  as  possible,  she  bends  forward 
from  the  hips  freely,  and  then  backwards  against 
the  resistance  exerted  by  the  hands  of  the  surgeon. 
This  is  repeated  five  times. 

15.  Then,  with  the  arms  stretched  out  from  the  side, 

she  twists  the  body  freely  towards  the  side  of  the 
concavity;  then  she  twists  backwards  towards  the 
side  of  the  convexity  against  the  resistance  afforded 
by  the  hands  of  the  surgeon,  one  hand  resting 
against  the  ribs  forming  the  convexity  of  the  cur- 
vature at  the  back  and  the  other  against  the  ribs 
that  are  prominent  below  the  breast  in  front.  This 
exercise  is  repeated  five  times. 

1 6.  The  patient  is  then  bent  backwards  and  to  the  side 

of  the  convexity  of  the  curvature  over  the  knee  of 
the  surgeon,  so  that  her  waist  rests  through  the 
bulging  ribs  across  his  knee,  while  the  shoulder 
on  that  side  is  twisted  still  further  backward.  In 
other  words,  the  position  assumed  is  the  one,  both 
as  to  flexion  and  rotation,  which  most  nearly 
corrects  or  over-corrects  the  spinal  deformity. 
Lying  lax  in  this  position,  the  patient  breathes 
deeply  ten  times. 

In  the  early  months  of  treatment  greater  improvement 
will  be  gained  if  the  patient  exercises  in  the  prone  position. 
Patients  with  lateral  curvature  are  able  to  lie  with  the  spine 
straighter  than  when  they  sit  or  stand,  and  the  success  of  the 
treatment  depends  greatly  upon  making  muscular  effort 
while  the  spine  is  at  its  best. 

Klapp's  "Creeping  Exercises"  are  not  only  useful  in 
scoliosis  but  are  equally  efficient  in  expanding  the  chest  by 
mobilizing  the  thoracic  vertebrae. 

164 


Re-Education     of    M ovements 

The  patient  kneels,  the  thighs  perpendicular,  the  elbows 
bent  so  that  the  arms  imitate  the  bow-leg  position  of  the 
dachshund  while  the  head  is  bent  far  back.  The  pelvis  is 
thus  above  the  shoulders  and  the  thoracic  portion  of  the  spine 
is  in  lordosis;  this  position  must  be  maintained  during  the 
creeping.  The  arm  is  advanced  and  stretched  before  the 
hand  touches  the  floor.  This  hand  then  turns  and  the  elbow 
is  bent  as  the  trunk  is  advanced  until  the  upper  arm  forms  a 
right  angle  with  the  trunk.  The  arm  thus  forms  the  axis 
over  which  the  thoracic  vertebrae  are  levered  by  the  drawing 
forward  of  the  other  arm,  the  scapula  of  the  supporting  arm 
forming  the  fulcrum  of  the  lever.  This  exercise  loosens  up 
the  thoracic  vertebrae  and  spreads  the  ribs  apart,  and  corrects 
torsion  of  the  spine  if  present.  The  thorax  expands  more, 
the  more  correctly  the  lordosis  of  the  thoracic  vertebrae  is 
localized  during  the  sideward  bend. 

RE-EDUCATION  OF  CO-ORDINATED  MOVEMENTS. 

In  locomotor  ataxia,  co-ordination  exercises  are  of  great 
value  in  regaining  control  of  the  voluntary  movements  which 
have  been  lost.  The  exercises  in  question  exert  no  effect  on 
the  lesions  and  the  best  results  are  attained  when  the  motor 
tract  is  intact.  It  is  not  necessary  to  employ  the  apparatus 
6f  Fraenkel  to  achieve  results;  in  fact,  good  results  are 
equally  achieved  without  apparatus.41 

In  executing  the  exercises  the  following  rules  must  be 
observed : 

1.  One  must  begin  with  simple  exercises;  first  with  the 

eyes  open  and  later  with  the  eyes  closed.     Each 
movement  must  be  executed  with  precision. 

2.  Fatigue  must  be  avoided,  hence  the  exercises  should 

be  taken  in  the  recumbent  and  later  in  the  sitting 
and  erect  postures.     Fatigue  may  be  avoided  by 

165 


Spondylotherapy 

counting  the  pulse  which,  when  increased  in  fre- 
quency beyond  the  norm,  indicates  that  the 
exercises  must  be  temporarily  suspended.  At 
first  the  seances  should  not  last  longer  than  about 
ten  minutes  and  later  the  entire  exercises,  includ- 
ing resting  periods  (to  enable  the  pulse  to  become 
normal)  should  not  exceed  thirty  minutes. 
3.  A  trained  assistant  for  supervising  the  exercises  is 
equally  as  important  as  the  patient's  persever- 
ance. 

Respecting  the  nature  of  the  exercises,  each  physician  will 
suggest  his  own  methods.  After  the  patient  succeeds  in  exe- 
cuting simple  movements  with  his  ataxic  extremities,  then 
walking  exercises  like  the  following  are  indicated : 

1.  Line- walking  in  a  straight  line. 

2.  Walking  at  a  mark  which  is  placed  on  a  wall  at  a 

limited  distance. 

3.  Obstacle-walking.     By  placing  books  on  their  long 

edges  about  20  inches  apart  and  then  directing  the 
patient  to  walk  over  them. 

4.  Stair-walking.     Ascending  and  descending  steps. 

SPINAL -HYDROTHERAPY. 

The  spinal-coil  has  replaced  the  Chapman  bags.  The 
former  consists  of  thin  rubber  tubes  through  which  a  con- 
tinuous current  of  water  of  any  desired  temperature  is  per- 
mitted to  flow  and  is  applied  to  the  spine  (never  directly 
upon  the  skin)  upon  a  thin  moist  compress.  The  bags  of 
Chapman  consist  of  the  usual  rubber  bags  (long  and  narrow) 
which  can  be  filled  with  ice  or  water  of  any  desired  tempera- 
ture and  are  placed  upon  the  vertebral  column.  Cold 
applied  to  the  cervical  spinal-region  (used  in  asthma  and 
cardiac  irritability)  has  a  primary  stimulating  action  suc- 
ceeded by  sedation.  Cold  applied  to  the  lumbar  spine, 

166 


Lumbar      Puncture 

determines  an  increased  flow  of  blood  toward  the  lower 
extremities  and  the  pelvic  organs.  Heat  applied  to  the 
lumbar  spine  is  said  to  diminish  the  flow  of  blood  to  the 
pelvic  organs  hence  it  is  indicated  in  excessive  menstruation. 
Cold  applied  to  the  entire  spinal  column  reduces  general 
reflex  irritability  and  is  employed  in  spinal  neurasthenia. 

In  the  rational  employment  of  hydrotherapy,  heat  or  cold 
water  must  be  applied  by  means  of  a  douche  to  definite 
vertebrae  to  elicit  specific  reflexes.  The  author,  however, 
regards  electricity  and  vibra-massage  as  more  convenient 
methods  insomuch  as  the  object  to  be  attained  irrespective 
of  the  method  employed  is  to  evoke  definite  reflexes.  Win- 
ternitz  suggests  the  use  of  cold  water  poured  over  the  back 
of  the  neck  for  relieving  nasal  congestion.  He  ascribes  the 
result  to  action  on  the  vaso -motor  center.  Elsewhere  (page 
284),  the  author  directs  attention  to  a  more  certain  and 
permanent  method  for  achieving  the  same  object. 

LUMBAR  PUNCTURE. 

Lumbar  puncture  is  usually  made  just  below  the  tip  of 
the  fourth  lumbar  spine  (fourth  interlaminal  space)  with  a 
sterilized  needle  about  three  inches  in  length  attached  to  a 
syringe  or  with  a  small  trocar  and  canula. 

If  a  horizontal  line  is  drawn  across  the  back  on  a  level 
with  the  highest  points  of  the  iliac  crests  it  will  cross  the  spine 
at  the  level  of  the  tip  of  the  4th  lumbar  spine. 

The  patient  should  lie  on  the  left  side  with  knees  drawn 
up  and  the  trunk  bent  forward.  The  skin  at  the  site  of  the 
puncture  may  be  frozen.  The  physician  places  his  finger 
on  the  tip  of  the  4th  lumbar  spine  and  introduces  the  needle 
half  an  inch  below  and  to  the  right  of  the  4th  lumbar  spine, 
and  directs  it  horizontally  forwards  and  a  little  inwards  until 
the  arachnoidal  space  is  reached.  When  the  syringe  is 

167 


Spondyloth     e     r    a   p    y 

detached,  the  fluid  escapes  in  drops  and  the  amount  per- 
mitted to  escape  at  a  single  seance  should  not,  as  a  rule, 
exceed  5  cc. 

Lumbar  puncture  is  indicated  for  the  relief  of  headaches 
of  various  origin  due  to  augmented  intracranial  pressure. 
Thus,  the  pains  secondary  to  herpes  zoster  have  been  relieved 
by  the  withdrawal  of  20  cc.  of  fluid  and  it  was  therefore 
assumed  that  hypertension  of  the  fluid  existed. 

Vertigo  and  tinnitus  dependent  on  increased  pressure  of 
fluid  in  the  internal  ear  are  likewise  relieved. 

MASSAGE. 

The  pressure  exerted  by  massage  influences  all  the 
tissues  within  its  reach.  It  increases  the  power  of  endurance 
and  abolishes  fatigue.  Experiments  on  frogs  show  that, 
after  the  muscles  have  been  exhausted,  their  loss  of  vigor  is 
soon  restored  by  massage,  whereas  rest  without  massage  has 
no  effect. 

Massage  increases  the  flow  of  blood  and  lymph.  Brunton 
has  shown  that  the  blood  passes  three  times  more  rapidly 
through  a  part  while  it  is  being  masseed  than  when  it  is  not. 
In  many  cases  there  is  an  increase  in  the  number  of  red 
corpuscles  and  in  the  hemoglobin.  Upon  the  nervous 
system,  massage,  if  properly  done,  has  a  sedative  effect. 

Therapeutically,  massage  accomplishes  the  following: 

1.  It  assists  the  peripheral  circulation  and  lessens  the 

work  of  the  heart. 

2.  In  tissues  accessible  to  manipulation  if  hastens  the 

resorption  of  exudations  and  separates  adhesions 
in  joints  and  tendon-sheaths. 

3.  It  augments  the  oxidizing  powers  of  the  blood,  thus 

modifying  disturbances  in  its  composition. 

168 


Massage 

4.  By  stimulating  the  sympathetic  nervous  system  it 

promotes  secretions  and  various  reflexes,  and  thus 
gives  relief  in  functional  derangements. 

5.  By  augmenting  the  flow  of  blood  in  the  muscles  it 

diminishes  congestion  of  the  viscera. 

6.  Wright  has  demonstrated  that  the  effect  of  massage 

on  an  infected  joint,  by  discharging  a  number  of 
bacteria  into  the  circulating  blood,  is  to  raise  the 
opsonic  index,  after  temporarily  lowering  it  in 
in  the  first  place. 

In  the  manipulation  of  joints  any  elevation  of  temperature 
signifies  extreme  caution  in  manipulation,  in  fact,  any  in- 
creased temperature  is  a  centra-indication  for  the  employ- 
ment of  massage  in  affections  of  the  joint.  When  it  is  a 
question  between  a  functional  and  an  organic  joint -lesion 
the  experience  of  the  author  shows  that  if  fever  follows 
passive  movements  of  the  joint  it  suggests  an  infectious  lesion 
and  the  leucocyte  count,  as  a  rule,  is  increased. 

Dowse  observes  that  ten  minutes  massage  of  the  spine  will 
increase  the  volume  of  the  pulse  and  the  temperature  gen- 
erally more  than  one  hour's  work  at  the  body  as  a  whole,  the 
spine  being  omitted. 

Fig.  48  demonstrates  a  series  of  visceral  reflexes  excited 
by  deep  pressure  at  the  vertebral  exits  of  the  various  spinal 
nerves.  The  foregoing  figure  has  been  elaborated  after  a 
series  of  very  careful  clinical  observations  by  the  author. 
Firm  pressure  is  usually  made  with  the  thumb  of  one  hand 
and  it  is  indeed  remarkable  how,  in  many  instances,  the 
symptoms  may  be  relieved  and  even  cured  by  such  deep  and 
firm  pressure  over  definite  regions.  It  is  evident  to  the 
reader  that  if  such  pressure  is  executed  promiscuously, 
counter-reflexes  are  evoked  which  nullify  the  reflexes  sought. 
In  fact,  the  symptoms  by  such  promiscuous  manipulation  may 

169 


S   p    o     n    d    y    I    o    t    h     e    r    a    p    y 


be  accentuated.  One  may  observe  quite  frequently  that  when 
pain  due  to  a  spinal  neuralgia  is  associated  with  a  point  of 
vertebral  tenderness,  temporary  inhibition  of  the  pain  may 
be  achieved  by  deep  pressure  on  the  sensitive  vertebral  area 
and,  in  this  respect,  pressure  may  accomplish  in  an  emergency 
almost  as  much  as  psychrotherapy.  If  the  pains  are  of 
visceral  origin  and  are  associated  with  a  point  of  vertebral 
tenderness,  pressure  upon  the  latter  point  is  decidedly  less 

BIGHT  LEFT 


corvtractio 
right  lim 


Cardiac 
inhibition 


enlargement 
of  liver.  - 

Contraction 
of.  intes- 
tine and 


ine 
liver. 


Contraction 
left  lung. 

"Contraction  of  heart 
ana  aorta. 

.Cardiac  inhibition. 

Dilatation  left 
.  lung. 

ilatation  of 
_ntestine  and 
.stomach. 

Contract ior\  of  stem* 
ach, intestine, and 
spleen. 


FIG.  48. — Visceral  reflexes  elicited  by  firm  pressure  at  definite  vertebral  areas. 

effective  in  relieving  the  pains.  When  it  is  necessary  to  make 
more  forcible  compression  at  the  vertebral  exits  of  the  sen- 
sitive nerves  the  author  employs  his  vibro -suppressor  (Fig. 
32)  with  a  smaller  pelote  or  he  makes  pressure  with  one  end 
of  the  rubber  of  a  pleximeter.  The  latter  is  shown  in  Fig.  2. 
Assuming  that  a  patient  has  a  neuralgia  of  the  cervico- 
occipital  nerves,  one  seeks  for  a  sensitive  point  at  the  verte- 
bral exits  of  the  cervical  nerves  usually  on  one  side  of  the 
spine.  As  a  rule,  muscular  spasm  of  the  cervical  muscles 

170 


Points        of       Election 

is  associated  with  such  a  vertebral  area  of  tenderness. 
Hence,  before  pressure  is  exerted  by  the  thumb  over  the  area 
of  sensitiveness,  the  head  is  thrown  backwards  so  as  to  relax 
the  muscles.  As  a  rule,  pressure  is  primarily  painful,  but  it 
soon  yields  to  continued  pressure  and  the  neuralgic  pains 
cease  at  once.  A  repetition  of  such  manipulation  may  be 
necessary  on  successive  days  before  the  pain  is  permanently 
relieved. 

The  author  has  observed  that  pressure  exerted  after  the 
foregoing  method  at  the  vertebral  exit  of  a  spinal  nerve  has 
usually  only  a  slight  effect  on  the  cutaneous  sensitiveness  in 
the  normal  subject.  If,  however,  the  nerve  is  the  site  of  a 
neuralgia,  a  decided  effect  can  be  observed  on  a  given  area 
of  skin -tenderness. 

Many  osteopaths  exercise  great  discretion  in  their  man- 
ipulations insomuch  as  they  do  not  massage  the  parts  affected, 
but  exert  pressure  upon  the  exits  of  the  spinal  nerves  which 
are  correlated  to  the  parts  involved.  Thus  the  parts  impli- 
cated are  merely  placed  at  rest  and  not  manipulated  until 
the  acute  symptoms  have  subsided. 

The  POINT  OF  ELECTION  for  pressure  at  the  vertebral  exits 
of  the  spinal  nerves  may  be  determined  (if  spasm  or  tender- 
ness is  absent)  by  noting  the  site  of  spasm  of  the  spinal 
musculature  (page  47),  when  an  organ  or  tissue  peripheral 
to  the  region  of  the  spine  is  manipulated  or  by  the  develop- 
ment of  an  area  of  vertebral  tenderness*  (page  71)  after 
such  manipulation. 

The  conductivity  of  a  nerve  may  be  temporarily  diminished 

*The  area  of  vertebral  tenderness  is  often  more  conspicuous  on  the  side  of  the 
spinal  column  opposite  to  the  source  of  cutaneous  irritation  and  this  fact  must 
be  taken  into  consideration  in  employing  our  therapeutic  manceuvers.  The 
foregoing  observation  aids  in  solving  the  dubitable  question  concerning  the 
propagation  through  the  spinal  cord  of  sensory  impressions  received  by  the 
skin;  in  all  probability,  the  impressions  after  entering  by  the  posterior  horn 
ascend  on  the  same  side,  whereas  other  impressions  cross  to  the  opposite  side. 

171 


Spondylotherapy 

or  abolished  by  external  pressure  (familiar  example  of  the 
limbs  "going  to  sleep")  without  annihilating  its  physical 
integrity. 

As  remarked  on  a  previous  page  (page  72),  some  writers 
associate  the  areas  of  paravertebral  tenderness  with  the 
vaso-motor  subcenters  in  the  cord  and  claim  that  when  the 
areas  have  become  chronic,  the  paravertebral  tissues  are 
infiltrated  and  thickened.  Here  deep  massage  of  the 
affected  areas  is  indicated. 

PSYCHROTHERAPY. 

In  the  treatment  of  localized  areas  of  vertebral  tenderness, 
nothing  in  the  experience  of  the  author  exceeds  cold  as  a 
remedial  measure.  To  attain  any  result,  however,  the  skin 
overlying  the  area  of  tenderness  must  be  distinctly  whitened 
and  frozen  and  this  condition  must  be  maintained  for  one  or 
two  minutes.  Very  often  a  single  application  suffices  for  the 
cure  of  a  neuralgic  affection  but,  in  other  instances,  the 
process  must  be  repeated  on  several  successive  days. 

The  author  has  never  noted  any  bad  effects  from  such 
radical  freezing  as  a  remedial  measure.  The  hyperemia 
resulting  may  be  assuaged  by  a  simple  dressing  of  zinc  oint- 
ment on  lint  fixed  to  the  part  with  adhesive  plaster.  Among 
the  agents  used  for  freezing  are  rhigolene  and  ether  which  are 
used  in  an  atomizer  and  directed  on  the  part  to  be  frozen. 

Recently  the  author  has  been  unable  to  obtain  rhigolene, 
hence  ether  was  employed  in  its  place.  Other  freezing  agents 
are  ethyl  chlorid  Bengue  and  Kelene,  which  are  sold  in  glass 
tubes  and  by  holding  one  of  the  latter  in  the  hand  a  fine  jet 
is  projected  on  the  area  to  be  frozen.  The  nozzle  is  held 
from  6  to  8  inches  from  the  skin.  The  latter  first  becomes 
pink,  then  a  deep  red  and  finally  white,  like  parchment. 
The  latter  degree  must  be  reached  and  maintained  for  several 
minutes. 

172 


Psych     r     o     t     h     e     r     a     p     y 

The  author  has  also  used  for  freezing  a  preparation  of 
benzine  (Distilled  between  35  and  45  degrees  C.),  which  is  a 
cheap  and  efficient  fluid  for  freezing.  The  odor  of  the  latter, 
like  ether,  may  be  objectionable,  but  this  may  be  corrected 
by  the  addition  of  some  essential  oil  to  either  preparation. 

Many  preparations  of  ether  on  the  market  are  quite  in- 
efficient, but  if  ethyl  chlorid  is  first  used  until  the  skin  is 
whitened,  almost  any  preparation  of  ether  will  maintain  the 
freezing  ad  libitum.  Ethyl  chlorid  or  Kelene  is  too  expen- 
sive if  used  extensively,  hence,  in  the  absence  of  a  reliable 
ether  preparation  for  freezing,  first  freeze  with  ethyl  chlorid 
or  Kelene  and  then  maintain  freezing  with  practically  any 
preparation  of  ether. 

The  foregoing  liquids  are  inflammable  and  should  not  be 
used  near  a  light. 

In  an  emergency,  a  piece  of  ice  sprinkled  with  fine  salt 
and  held  against  the  skin  by  means  of  a  towel  will  freeze  the 
part. 

The  author  has  had  no  personal  experience  with  either 
liquid  air  or  carbonic  acid  snow  for  freezing  purposes  and  for 
information  on  this  subject  the  reader  is  referred  elsewhere.43 

In  intractable  pains  due  to  lesions  at  the  vertebral  exits 
of  the  nerves,  the  author  has  had  recourse  to  what  he  calls 
reinforced  freezing.  It  consists  of  injecting  sterilized  water 
beneath  the  skin  over  the  part  to  be  frozen  or  directly  into  the 
tissue  until  an  appreciable  bulging  is  produced.  If  the 
freezing  solution  is  now  directed  on  the  protuberant  part,  a 
lump  of  ice  is  formed  under  the  skin  or  in  the  tissues. 
Respecting  the  rationale  of  congelation  the  author  directs  the 
reader  elsewhere42  to  his  investigations  on  the  subject.  Vide 
page  187,  concerning  the  use  of  freezing  in  spinal  neuralgias.* 

*Vide  page  367,  concerning  the  employment  of  concussion  for  the  relief  of  pain. 

173 


S   p     on     d    y    I    o     t    h     e     r    a   p    y 


THERMOTHERAPY. 


This  refers  to  heat  as  a  therapeutic  agent.     Media  having 
a  temperature  above  that  of  the  body  are  referred  to  as  hot 


FIG.  49. — Cutaneous  areas  for  influencing  the  viscera. 

and  as  very  hot,  when  the  temperature  exceeds  104  degrees  F. 
(40  degrees  C.). 

174 


Vibratory     Massage 

Respecting  the  physiologic  effects  of  heat,  it  suffices  to 
say,  that  a  prolonged  application  of  a  high  temperature  is 
primarily  an  excitant,  and  secondarily,  a  depressant ;  a  brief 
application,  however,  is  strongly  excitant  and  the  depressing 
effects,  if  any,  are  imperceptible. 

The  viscera  are  influenced  reflexly  through  cutaneous 
areas  (Fig.  49)  which  have  been  definitely  established  and 
are  of  great  clinical  importance.  As  a  rule,  the  cutaneous 
reflex  areas  overlie  the  individual  viscera,  but  in  the  author's 
experience,  the  most  pronounced  effects  are  achieved  by  the 
application  of  heat  (very  hot  water  in  small  rubber  bags) 
over  the  different  vertebral  regions;  a  brief  application  to 
secure  stimulating  effects  and  a  prolonged  application  to 
achieve  sedative  action. 

Von  Bernd,  by  means  of  an  apparatus  which  consists  of  a 
transformer,  a  high  frequency  current  is  obtained  from  the 
usual  electric  supply  and  which,  when  passed  through  the 
tissues,  subjects  the  latter  to  any  degree  of  heat  which  can 
be  modified  at  will.  With  this  apparatus  the  gonococci  in 
an  infected  joint  have  been  killed  within  one-half  hour. 

ELECTRO -THERMAL  PADS  of  any  size,  attachable  to  an 
electric  light  socket,  are  now  purchasable  and  supply  a 
uniform  source  of  heat.  They  are  also  made  to  contain 
material  used  for  cataplasms,  thus  obviating  the  necessity 
of  changing  the  latter  to  secure  a  constant  supply  of  warmth.* 

VIBRATORY  MASSAGE    (SISMOTHERAPY). 

Vibra-massage  or  mechanic  vibration  has  achieved  some 
distinction  as  a  remedial  measure,  but  owing  to  its  indis- 
criminate application  without  regard  to  physiologic  principles, 
most  of  the  results  attained  by  its  use  must  be  attributed  to 

*Made  by  the  F.  R.  Whittlesey  Co.,  591  66th  Street,  Oakland,  Cal. 

175 


S  p    o    n     d    y    I    o     the     r    a    p    y 

suggestion.  The  author  only  seeks  to  discuss  vibra -massage 
with  reference  to  its  spinal  application,  and  it  will  be  evident 
to  the  reader  if  he  has  given  careful  consideration  to  the 
vertebral  reflexes  (page  7),  that  the  manipulation  of 
definite  vertebrae  corresponds  with  the  elicitation  of  definite 
reflexes  but,  if  the  vertebrae  are  promiscuously  handled, 
counter -reflexes  are  evoked,  which  may  often  accentuate  the 
reflexes  in  action  and  thus  intensify  the  co-existing  symptoms. 

The  foregoing  sentence  has  been  quoted  several  times 
throughout  this  book,  but  it  is  deserving  of  repetition. 

In  the  therapeutic  elicitation  of  the  vertebral  reflexes,  the 
only  kind  of  vibratory  apparatus  which  is  effective  is  one 
giving  the  PERCUSSION  STROKE.  All  other  motions,  such  as 
oscillations,  shaking  and  friction,  interfere  with  the  results. 
In  other  words,  it  is  concussion  and  not  vibration  which  is 
effective. 

Vibration  is  milder  and  of  higher  frequency  than  per- 
cussion. 

The  author  has  tested  very  many  devices  for  vibra- 
massage  and  has  been  disappointed  with  the  results.  Thus 
there  are  many  instruments  which  concuss,  but  in  so  doing, 
they  also  produce  considerable  friction,  which  is  undesirable 
in  prolonged  seances  with  the  apparatus. 

When  the  author  first  employed  vibra-massage  with  in- 
adequate apparatus,  the  friction  provoked  in  association 
with  concussion,  resulted  in  severe  wounds  over  the  spinous 
processes.  Such  accidents  no  longer  occur  in  the  author's 
experience,  although  the  spinous  processes  may  become 
tender  owing  to  a  mechanic  periostitis  which  is  of  little  or  no 
consequence. 

With  an  apparatus  which  does  not  cause  friction,  the 
concussors  (Fig.  50)  may  be  applied  directly  to  the  spinous 
process  or  processes  and  the  application  can  be  prolonged 

176 


Vibratory     Massage 

for  several  minutes  at  a  time.  In  the  event  friction  attends 
the  use  of  the  apparatus,  one  must  interpose  some  medium 
between  the  concussor  and  the  spinous  process.  Here  a 
strip  of  linoleum  is  efficient  and  the  treatment  must  be  inter- 
rupted at  once  if  the  patient  complains  of  a  burning  sen- 
sation.* The  author's  apparatus  (Fig.  50)  is  essentially  a 


FIG.  50. — The  author's  pneumatic  hammer  with  concussors. 

pneumatic  hammer  giving  a  stroke  of  i  \  inches  and  operated 
by  compressed  air.  The  force  of  the  concussion -blow  may 
be  regulated  by  a  stop -cock  or  by  the  pressure  of  the  con-, 
cussor  on  the  spinous  process.  To  start  the  action  of  the 
hammer  it  is  often  necessary  to  place  the  finger  on  the  suction 
opening  and  then  suddenly  release  it  or  strike  the  concussor 
forcibly  with  the  hand.  The  absence  of  latch  pins,  springs 
or  plugs  avoids  any  waste  of  air  and  insures  a  steady  working 

*If  a  layer  of  rubber  (i  cm.  in  thickness)  covers  the  surface  of  the  concussor,  no 
heat  is  generated  and  there  is  no  necessity  for  interposing  a  medium  between 
the  skin  and  the  concussor. 

177 


S    p    o    n     d    y    I    o     t    h     e    r    a   p    y 

hammer.  No  vibration  is  transmitted  to  the  operator's  hand. 
Although  quite  heavy,  it  is  easily  manipulated,  being  sus- 
pended from  the  ceiling  by  means  of  a  counter-weight.  The 
concussors  are  of  different  sizes  to  include  one,  two,  three  or 
more  spinous  processes.  The  apparatus  in  question  is  only 
available  when  compressed  air  of  considerable  pressure  can 
be  obtained,  but  this  is  rarely  objectionable  insomuch  as  all 
modern  office  buildings  are  equipped  with  air  compressors. 

Smaller  pneumatic  hammers  are  procurable,  but  they  can 
only  be  regarded  as  mere  toys  for  the  elicitation  of  the  verte- 
bral reflexes. 

An  efficient  percussion -stroke  may  be  obtained  from  an 
electric  apparatus  (Fig.  51).  It  strikes  from  3,500  to  5,000 
blows  per  minute,  and  the  force  of  the  blow  varies  according 
to  the  pressure  on  the  spine  by  the  concussor  in  the  vibrator 
from  an  imperceptible  to  the  maximum  blow.  It  is  run  with  a 
J  H.  P.  and  may  be  arranged  for  any  kind  of  an  electric 
current.  The  only  objectionable  feature  is  its  price  (about 
$160). 

If  the  physician  cannot  obtain  an  efficient  apparatus,  then 
a  hammer  and  pleximeter  (Fig.  2 )  may  be  used  with  fairly 
good  results.  In  the  excellent  book44  of  Doctor  M.  L.  H. 
Arnold  Snow,  the  author  specially  cautions  the  reader  to 
avoid  the  spinous  processes  in  the  application  of  vibration. 
In  my  opinion,  this  caution  is  absolutely  unnecessary.  Many 
times  a  day,  for  years,  the  author  has  concussed  the  spinous 
processes  most  unmercifully,  yet  he  has  never  noted  any  un- 
toward results.  His  experience  in  this  regard,  prompts  him 
to  side  with  those  who  hold  that  spinal  concussion  and 
cerebral  commotion  cannot  give  rise  to  the  symptoms  of  a 
traumatic  neurosis,  for  otherwise,  many  of  his  patients  would 
have  been  the  victims  of  "railway  spine,"  insomuch  as  they 
have  been  subjected  to  as  much  concussion  as  they  would 

178 


FIG.  51. — Electric  concussion- hammer. 


Spondyljtherapy 

have  experienced  in  several  railroad  accidents  without  suffer- 
ing from  any  untoward  results.* 

It  will  be  noted  in  the  special  chapters  that  vibra-massage 
is,  in  some  instances,  more  efficient  than  the  sinusoidal 
current  for  the  elicitation  of  the  vertebral  reflexes.  It  may 
also  be  noted,  that  if  treatment  with  either  method  is  too 
prolonged,  the  spinal  visceral  reflexes  become  exhausted  and 
a  condition  other  than  that  sought  for  will  result.  Experience 
only  will  determine  the  time  necessary  for  each  treatment, 
although  the  relief  of  symptoms  is  a  fair  gauge  for  the  dura- 
tion of  a  seance. 

Reference  has  been  made  on  page  169  to  the  increase  of 
temperature  following  massage  of  the  spine,  but  in  the 
opinion  of  the  author,  concussion  with  the  pneumatic  hammer 
is  decidedly  more  efficient.  Concussion  of  any  of  the 
spinous  processes  will  elevate  the  temperature,  but  the  best 
results  are  achieved  when  the  spinous  process  of  the  yth 
cervical  vertebra  is  concussed.  The  two  following  cases  of 
myocarditis  are  cited  to  show  the  effects  of  concussion  on  the 
spinous  process  of  the  yth  cervical  vertebra: 

CASE  i. 

Temperature  before  concussion 97-2°  F. 

"  after  "  for  4  minutes  ..98°      F. 

u  "  "  "  8         "       ..98.8°F. 

CASE  II. 

Temperature  before  concussion 96. 4°  F. 

"  after  "  for  4  minutes... 98°      F. 

No  such  effects  could  be  produced  with  the  sinusoidal 
current. 


*The  fear  of  employing  forcible  concussion  on  the  spinous  processes  and  the  use 
of  inefficient  apparatus  are  responsible  for  the  inefficient  results  achieved  by 
vibra-massage. 

180 


Vibratory     Massage 

The  author  does  not  believe  that  elevation  of  temperature 
following  concussion  of  the  yth  cervical  vertebra  is  dependent 
on  stimulation  of  a  problematic  thermogenic  center,  but  to 
a  stimulation  of  the  heart  (heart  reflex). 

In  fever,  the  author  has  never  succeeded  in  reducing  the 
temperature  by  aid  of  concussion  of  any  of  the  spinous 
processes,  although  his  efforts  have  been  many.  The 
employment  of  concussion  to  induce  analgesia  is  discussed 
on  page  367. 


S  p     o    n    d    y    I    o     the    r    a    p    y 


CHAPTER  VI. 

PSEUDO -VISCERAL  DISEASES. 

NEURALGIA — INTERCOSTAL  NEURALGIA — DIFFERENTIAL  DIAGNOSIS — 
PSEUDO- APPENDICITIS — PSEUDO-CEREBRAL  DISEASE — PSEUDO- AN- 
GINA PECTORIS — PSEUDO-ARRHYTHMIA  —  PSEUDO-ESOPHAGISMUS 
— PSEUDO-NEPHROLITHIASIS  —  PSEUDO-DYSPEPSIA  —  PSEUDO- 
CHOLELITHIASIS — PSEUDO-MAMMARY  NEOPLASMS. 

T^VERY  physician  owes  a  modicum  of  his  success  to  the 
•*-'  recognition  and  successful  treatment  of  some  special 
disease.  In  this  respect,  the  author's  talismanic  affection  is 
neuralgia  of  the  spinal  nerves  with  their  bizarre  and  protean 
manifestations.  The  author  may  be  pardoned  for  his 
apparent  presumption  when  he  asseverates  that  he  feels 
justified  in  having  written  this  book,  if  for  no  other  reason 
than  to  direct  the  attention  of  the  profession  to  recognize  the 
greatest  simulator  of  visceral  diseases,  viz.,  NEURALGIA  OF 

THE  SPINAL  NERVES. 

It  very  frequently  happens  that  neuralgia  of  the  spinal 
nerves  may  be  accompanied  by  visceral  symptoms  of  such 
prominence  that  the  neuralgia  is  overlooked  and  unsuccessful 
treatment  is  directed  toward  the  supposititious  visceral 
disease.  Such  cases,  while  presenting  varied  clinical  pictures, 
are  frequently  analogous,  if  only  atypically  so,  to  gastric, 
cardiac,  renal,  vesical  and  intestinal  affections.  The 
neuralgic  paroxysms  occurring  in  spinal  diseases  like  tabes 
are  manifested  by  symptoms  occurring  in  organs  like  the 
stomach,  intestine,  bladder,  etc.  Here,  like  in  neuralgias  of 
the  spinal  nerves,  we  are  dealing  with  lesions  represented  by 
nerve-root  symptoms.  Many  pseudo-visceral  diseases  may 
be  partially  explained  by  the  anastomosis  existing  between 

182 


Pseudo  -Viscera  I      D  i  s 


eases 


the  spinal  and  sympathetic  nerves  (vide  sympathetic  sensa- 
tions, page  57).  Neuralgia  of  the  intercostal  nerves  most 
frequently  simulates  visceral  disease. 

The  upper  group  of  the  thoracic  nerves  is  distributed 
entirely  to  the  thoracic  wall  and  the  lower  group  (yth  to  i  ith) 
is  distributed  partly  to  the  thoracic  and  partly  to  the  abdom- 
inal wall.  It  is  the  latter  fact  which  often  makes  the  recog- 


INTERNAL  BRANCH 

Longissimus  dorsi 


Bemispinalis  dorsi 
Multifldus  spinae 

Superior  eosto-transversa 
ligament 

DORSAL  ROO 
VENTRAL  ROOT- 
RECURRENT  BRANCH 
SYMPA  THETIC 
GANGLION 

MEDIAL  BRANCH 
BRANCH  TO  AORTA 

(Esophagus 


Internal  mammary  artery 
Transverse  thoracic  muscle 


STERNUM 


Ilio-eostalis  dcrsi 

EXTERNAL  BRANCH 
J>nKTF.KTnK  PRIMARY 

DIVISION 
ANTERIOR  PRIMARY 

DIVISION 
Internal  intercostal  muscle 

External  intercostal 


LATERAL  CUTANEOUS 
BRANCH 


ANTERIOR  BRANCH 


Anterior  Intercostal  membrane 

FIG.  52. — Diagram  of  the  distribution  of  a  typical  thoracic  nerve    (Morris). 

nition  of  intercostal  neuralgia  difficult,  insomuch  as  the  word 
intercostal  (between  the  ribs),  connotes  an  erroneous  topog- 
raphy in  the  localization  of  pain.  It  is  evident  that  in  dis- 
eases affectingthe  nerve-trunks  at  or  near  their  origin,  the  pain 
is  referred  to  their  peripheral  terminations.  Thus,  in  Pott's 
disease  of  the  spine,  the  pain  is  referred  to  the  belly,  owing 
to  the  irritation  of  the  nerve-trunks  at  their  origin.  In 

183 


S  p    o    n    d    y    I    o    the    r    a    p    y 


pneumonia  or  in  pleural  affections,  the  pain  may  be  referred 
to  the  abdomen  or  the  right  iliac  fossa  and  may  suggest 
appendicitis.  Here  the  lower  thoraco -abdominal  nerves  are 
irritated  owing  to  their  juxtaposition  to  the  pleura. 


pectoral  is  major. 


Supracl av  i  cul ar 
Branch  of 
cervical 
Plexus 


Pectoral is 

minor 


Iiio- 
Irfguinal 


FIG.  53. — Cutaneous  nerves  of  the  thorax  and  abdomen  viewed  from  the 
side  (Morris,  after  Henle). 

A  typical  thoracic  nerve  is  shown  in  Fig.  52.  In  the 
posterior  parts  of  the  intercostal  spaces,  muscular  branches 
are  distributed  to  the  levatores  costarum  and  the  nerves  pass 
forward  between  the  external  and  internal  intercostals  and  di- 
vide into:  i.  Lateral  branches,  which  after  penetrating  the 
external  intercostals  near  the  mid-axilliary  line,  divide  into 
anterior  and  posterior  branches.  2.  Anterior  branches, 
which  at  a  short  distance  from  the  sternum  give  off  terminal 

134 


Neuralgia 

branches.     Fig.  53  shows  the  cutaneous  nerves  of  the  thorax 
and  abdomen. 

To  properly  appreciate  this  subject  it  will  be  necessary 
first  to  describe  neuralgias  in  general  and  later  intercostal 
neuralgia  in  particular. 

NEURALGIA. 

Neuralgia  is  usually  a  unilateral  affection  associated  with 
paroxysmal  pains  and  painful  areas  (points  douloureux}  on 
pressure,  at  certain  points  in  the  course  of  the  nerve  where 
the  latter  passes  through  bones,  muscles,  or  lies  superficially. 
The  painful  areas  are  also  present  in  the  interparoxysmal 
periods. 

Associated  symptoms  of  neuralgia  are :  disturbances  of 
sensation  (hyperesthesia  or  anesthesia),  vaso-motor  symp- 
toms, anemia  or  hyperemia  of  the  skin  and  increase  of  the 
secretions,  trophic  disturbances  and  localized  clonic  spasm 
of  the  muscles. 

The  pains  in  neuralgia  are  usually  localized  to  a  single 
nerve,  but  at  the  height  of  the  paroxysm  the  pains  may 
radiate  to  other  nerves. 

MUSCULAR  PAINS  show  diffused  areas  of  tenderness  in 
the  muscles,  are  dependent  on  movement  and  are  not 
paroxysmal. 

Malaria  has  often  been  accused  as  an  etiological  factor 
in  neuralgia  because  the  pains  are  paroxysmal,  but  this  is  an 
erroneous  supposition  insomuch  as  the  pains  of  neuralgia, 
irrespective  of  cause,  are  paroxysmal. 

Again,  syphilis  is  accepted  as  a  cause  because  the  parox- 
ysmal onset  occurs  at  night.  But  this  feature  is  common  to 
many  neuralgias.  On  the  other  hand,  the  absence  of  noc- 
turnal exacerbations  speaks  against  syphilis. 

Among  the  more  frequent  etiologic  factors  of  neuralgia  are : 

185 


Spondyloth     e    r    a    p    y 

1.  Mechanic  (pressure  on  nerve  from  growths,  exuda- 

tions, etc). 

2.  Thermic  (chilling  draughts,  etc). 

3.  Toxic    (drugs,    infectious    diseases    and    nutritive 

disturbances). 

One  must  not  forget  that,  whereas  in  the  majority  of 
instances  intercostal  neuralgia  is  primarily  due  to  cold  (with 
the  lesion  at  the  vertebral  exit  of  the  nerve),  it  may  be  second- 
ary to  vertebral  disease,  spinal  meningitis  and  pressure  from 
an  aneurysm,  tumor,  etc.* 

INTERCOSTAL  NEURALGIA. 

As  before  remarked,  the  diagnosis  of  this  affection  is  not 
difficult  when  the  middle  intercostal  nerves  are  involved; 
the  difficulty  arises  when  the  lower  group  is  involved,  owing 
to  the  distribution  of  the  nerves  to  the  skin  of  the  lateral  and 
anterior  abdominal  wall. 

In  intercostal  neuralgia  three  painful  points  are  invariably 
found  on  pressure,  viz.,  at  the  vertebral  exit  of  the  nerve,  in 
the  mid -axillary  line  and  in  the  median  line  of  the  thoracic 
and  abdominal  walls.  The  point  at  the  vertebral  exit  is 
most  constant  and  the  method  for  the  elicitation  of  the  pain 
or  tenderness  has  already  been  described  on  page  66.  Here 
a  word  of  caution  is  necessary.  Unless  the  muscles  are 
relaxed  the  contracted  muscular  fibers  over  the  areas  of 
tenderness  will  prevent  elicitation  of  pain  upon  pressure. 

Presuming  the  patient  suffers  from  pain  dependent  on  a 
lesion  of  the  spinal  nerve,  our  primary  endeavor  is  to  locate 
the  vertebral  point  of  tenderness.  Insomuch  as  several 
points  of  tenderness  may  be  elicited,  we  proceed  to  locate 

*In  neuralgia  and  neuritis  of  the  intercostal  nerves,  pain  is  frequently  accentuated 
when  the  patients  lean  far  forward.  The  stooping  attitude  in  corpulent 
persons  may  cause  intercostal  pains  (pressure  of  the  ribs  on  the  nerves  or 
traction),  and  in  such  instances  cure  may  be  achieved  by  instructing  the 
patients  to  assume  the  erect  posture. 

186 


Intercostal       Neuralgia 

the  point  first  from  above  and,  when  the  sensitive  area  is 
reached,  it  is  marked  with  a  dermograph  (skin-pencil). 
Next  we  locate  the  sensitive  area  from  below  and,  when  the 
latter  is  reached,  it  is  also  marked.  It  is  wise  to  compare 
the  sensitiveness  on  both  sides  of  the  spine  although,  as  a 
rule,  the  neuralgia  is  unilateral. 

The  author  makes  exclusive  use  of  freezing  (page  172) 
for  diagnostic  and  therapeutic  purposes.  The  area  to  be 
frozen  in  neuralgia  of  a  spinal  nerve  or  nerves  is  that  included 
between  the  two  pencil  marks  just  referred  to. 

It  will  be  noted  that  if  the  mid-axilliary  and  sternal 
points  of  tenderness  are  marked  with  a  pencil  and  freezing 
is  executed  at  the  vertebral  point,  the  other  points  of  tender- 
ness disappear,  or  will  be,  at  least,  less  sensitive  after  a  single 
freezing. 

This  latter  test  is  diagnostic  of  neuralgia  of  any  of  the 
spinal  nerves.  Several  freezings,  however,  may  be  necessary 
before  the  neuralgia  is  cured. 

In  practically  every  case  the  author  ever  saw,  when  a 
diagnosis  of  neuralgia  of  a  spinal  nerve  was  made,  the  attend- 
ing physician  had  applied  his  counterirritant  at  the  site  of 
the  pain,  i.  e.,  at  the  peripheral  distribution  of  the  nerve  and 
not  as  he  should  have  done  near  the  site  of  the  lesion,  viz., 
the  vertebral  exit  of  the  affected  nerve. 

If  the  negative  pole  of  a  Galvanic  current  is  fixed  at  an 
indifferent  spot,  and  the  positive  pole  is  placed  successively 
over  the  other  sensitive  points,  neuralgic  pain  is  likewise  in- 
hibited, but  this  method  cannot  compare  in  accuracy  nor  in 
rapidity  with  the  freezing  method. 

The  author  has  often  utilized  the  following  method  in 
the  absence  of  a  freezing  apparatus;  firm  pressure  is  made 
with  the  thumb  and  maintained  for  several  minutes  at  the 
vertebral  area  of  tenderness.  At  first,  the  pains  are  accen- 

187 


S    p     o    n    d    y    I    o     t    h     e     r    a   p    y 

tuated,  but  later  they  are  mitigated  or  disappear.  The 
method  cited  is  used  in  an  emergency  and  is  decidedly  less 
radical  than  freezing.  Reference  has-  been  made  to  it  on 
page  171. 

It  may  happen,  and  indeed  it  often  does,  insomuch  as 
cold  is  the  common  etiologic  factor  of  neuralgia  and  muscular 
rheumatism,  that  both  affections  coexist.  Here  Faradism 
temporarily  inhibits  the  pain  of  rheumatism,  leaving  the  pain 
from  other  causes  uninfluenced.  Again,  Faradism  will 
accentuate  the  painful  areas  of  muscular  rheumatism. 

Congelation  (freezing)  may  be  employed  as  a  means  of 
diagnosis  for  the  following  purposes : 

A.  To   diagnose    neuralgia    of    central    from    one    of 

peripheral  origin. 

B.  To  differentiate  neuralgia  from  neuritis. 

C.  To  localize  the  lesion  in  neuralgia. 

A.  If  a  nerve  the  seat  of  neuralgia  is  frozen  nearest  its 
point  of  origin,  the  pain  will  disappear  if  the  neuralgia  is  of 
peripheral  origin  and  it  will  persist  if  of  central  origin.     In 
the  absence  of  spontaneous  pain  the  painful  points  in  the 
course  of  the  nerve-distribution  may  serve  as  guides. 

B.  Freezing  is  a  specific  for  all  forms  of  uncomplicated 
neuralgia,  provided  it  can  be  executed  near  the  point  of 
origin  of  the  involved  nerve,  i.  e.,  close  to  the  site  of  the 
lesion.     If,  however,  the  pain  is  central  in  origin  or  due  to  a 
neuritis,  the  pain,  as  a  rule,  will  not  be  inhibited.      Many 
years  ago  I  suggested  freezing  for  the  pains  associated  with 
herpes  zoster.     In  some  instances  it  was  marvelously  efficient, 
but  in  the  majority  of  cases,  no  relief  followed.    Here  the 
pain  was  of  central  origin,  due  presumably  to  disease  of  the 
intervertebral  ganglion. 

C.  The  following  cases  illustrate  the  employment  of 
freezing  for  localizing  pain: 

188 


Intercostal       Neuralgia 

Case  I.  Male.  In  a  row  received  many  cuts  on  the 
scalp.  Various  cicatrices  resulted.  He  suffered 
from  ill-defined  neuralgia  located  in  the  scalp.  All 
cicatrices  were  equally  sensitive  to  pressure. 
Freezing  was  conducted  at  the  exit  of  the  occipital 
nerves  in  the  neck  without  effect.  Then  the  indi- 
vidual scars  were  successively  frozen  during  a 
paroxysm.  Pain  continued  until  one  cicatrix  in  the 
occipital  region  was  frozen,  when  the  pain  ceased 
at  once.  Excision  of  the  latter  cicatrix  resulted  in 
cure. 

Case  II.  Case  of  occipital  neuralgia.  Usual  painful 
points.  Freezing  conducted  during  a  painful 
paroxysm.  When  freezing  was  made  over  a  particu- 
lar sensitive  point  the  pain  ceased.  Palpation  at 
this  point  demonstrated  the  presence  of  a  little 
growth.  Cure  after  removal  of  a  small  neuroma. 

Case  III.  Neuralgia  of  the  trigeminus  (prosopalgia) . 
Freezing  during  a  painful  paroxysm  at  the  supra- 
orbital  foramen,  infra-orbital  foramen  and  mental 
foramen  respectively.  Relief  from  the  pain  when 
congelation  was  conducted  at  the  latter  point. 
Examination  of  the  teeth  of  the  lower  jaw  showed 
the  presence  of  a  carious  tooth,  which,  when  ex- 
tracted, was  followed  by  a  cure. 

DIFFERENTIAL  DIAGNOSIS. 

Visceral  diseases  are  frequently  confounded  with  inter- 
costal neuralgia.  Here,  as  a  rule,  we  find  only  a  vertebral 
area  of  tenderness,  whereas  the  mid-axillary  and  sternal 
points  of  tenderness  are  absent.  Again,  freezing  at  the 
vertebral  area  of  tenderness  is  not  followed  by  any  relief  of 
the  pain.  In  visceral  disease  simulating  intercostal  neuralgia, 
one  may  demonstrate  dermatomes  (page  58)  which,  like 
the  vertebral  tenderness,  become  accentuated  after  palpation 
of  special  organs.  Supposing,  for  example,  one  finds  a 

189 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

sensitive  area  over  the  stomach.  If  pressure  sufficiently 
great  is  made  at  this  point  to  induce  pain,  the  area  of  verte- 
bral tenderness  in  my  experience,  becomes  accentuated  and 
the  dermatomes  are  more  easily  demonstrated. 

In  localizing  the  latter,  however,  one  must  not  forget  that 
hyperesthetic  zones  may  also  be  demonstrated  in  neuralgia. 

As  a  rule,  in  visceral  disease,  vertebral  tenderness  may 
be  demonstrated  on  both  sides  of  the  spinal  column,  whereas, 
in  intercostal  neuralgia,  the  sensitiveness  is  unilateral. 
Bilateral  sensitiveness  in  the  latter  affection  suggests  an 
intravertebral  lesion. 

Whereas,  in  intercostal  neuralgia,  pressure  on  the  area  of 
vertebral  tenderness  may  reproduce  the  pains  from  which  the 
patient  suffers,  in  vertebral  tenderness  of  visceral  origin,  like 
pressure  may  reproduce  other  symptoms.  Thus  arrhythmia 
may  be  reproduced  or  accentuated  when  the  area  of  vertebral 
tenderness  is  firmly  compressed.  Similarly,  in  gastric 
disease,  pressure  on  the  sensitive  vertebral  area  may  cause 
eructations  of  gas  and  other  symptoms  suggestive  of  a 
gastric  anomaly. 

The  aphonia  and  dysphonia  of  LARYNGITIS  (acute)  may 
be  differentiated  from  like  symptoms  due  to  other  laryngeal 
affections  by  the  following  simple  method :  First,  mark 
with  a  pencil  on  either  side  of  the  neck  the  approximate 
point  in  the  thyro-hyoid  membrane  where  the  internal 
laryngeal  branch  of  the  superior  laryngeal,  the  nerve  of 
sensation  to  the  larynx,  passes  into  the  latter  organ.  Next, 
thoroughly  freeze  the  points  marked  with  the  pencil.  Relief 
is,  as  a  rule,  almost  instantaneous  and  is  of  signal  advantage 
to  many  professionals.  In  some  instances,  the  restoration 
of  the  voice  is  of  only  short  duration  and  freezing  may  have 
to  be  repeated  several  times. 

The  author  desires  to  illustrate  by  the  citation  of  a  few 

190 


P  s  e  u  d  o   -   A  p  p    e   n    die   it  is 

cases  what  he  intends  to  convey  by  the  phrase,  pseudovisceral 
disease.  In  this  respect  he  will  be  brief,  for  in  this  epoch  of 
therapeutic  skepticism,  one  dare  not  report  phenomenal 
cures  without  being  accused  of  extravagant  representation, 
misinterpretation  or,  if  the  calumniator  is  charitable,  of 
auto-suggestion. 

PSEUDO  -APPENDICITIS . 
LUMBO -ABDOMINAL    NEURALGIA    which    involves    the    SIX 

branches  of  the  lumbar  plexus  is  frequently  mistaken  for 
appendicitis.  The  author  has  observed  many  patients  who 
had  even  contemplated  an  operation  for  the  relief  of  their 
pain,  but  who  were  cured  after  one  or  several  freezings  at 
the  vertebral  exits  of  the  sensitive  nerves.  One  patient  in 
particular  is  recalled  who  was  seen  in  consultation,  and  who, 
despite  the  protests  of  the  author,  had  his  appendix  removed. 
After  the  operation  the  persistent  pains  of  a  lumbo-abdom- 
inal  neuralgia  were  cured  by  several  freezings. 

These  cases  are  not  difficult  to  diagnose.  Painful  areas 
are  located  near  the  lumbar  portion  of  the  vertebral  column, 
in  the  center  of  the  iliac  crests,  over  the  symphysis  in  the 
hypogastric  region,  at  the  scrotum  in  the  male  and  at  the 
labium  majus  in  the  female. 

Pain  in  these  patients  is  also  felt  on  the  anterior  surface 
of  the  thigh  corresponding  to  the  area  of  distribution  of  the 
lumbo-inguinal  nerve. 

Difficulty  in  diagnosis  in  these  cases  is  often  hampered 
by  the  fact  that  there  is  a  circumscribed  tonic  spasm  of  the 
abdominal  muscles  in  the  ileocecal  region  which  may  be 
mistaken  for  a  deep-seated  intumescence. 

We  have  long  recognized  the  almost  intelligent  function  of 
muscles  whether  displayed  in  fixing  a  diseased  joint  or  spine, 
or  in  protecting  an  inflamed  serous  membrane.  The  fact  is, 
that  in  spinal  neuralgias,  spasm  of  the  muscles  can  almost 

191 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

invariably  be  demonstrated  and  it  is  a  nerve-root  symptom. 
When  the  lesion,  as  in  neuritis,  is  destructive  rather  than 
irritative,  muscular  atrophy  and  not  spasm  is  the  con- 
comitant sign. 

One  would  naturally  conclude  that  a  skilled  diagnostician 
could  not  possibly  err  in  mistaking  a  lumbo -abdominal 
neuralgia  for  appendicitis.  In  Paris,  the  author  recently 
saw  an  American  lady  who  was  suffering  from  atrocious 
pains  in  the  ileocecal  region.  She  consulted  some  of  the 
leading  surgical  and  medical  clinicians  of  Europe.  All  were 
unanimous  in  their  conviction  that  she  had  appendicitis,  and 
that  an  immediate  operation  was  imperative  and  the  only 
means  of  arresting  the  pains.  An  examination  demonstrated 
the  spasm  of  the  abdominal  muscles  in  the  neighborhood 
of  the  appendix,  which,  at  one  point,  was  so  circumscribed 
as  to  awaken  the  suspicion  of  a  tumor.  A  point  over  the 
appendix  was  exquisitely  tender.  There  were  the  usual 
tender  points  elsewhere  in  the  gluteal  region,  on  the  outside 
of  the  thigh,  symphysis  pubis  and  at  the  vertebral  exits  of  the 
involved  nerves.  A  single  freezing  gave  immediate  relief, 
although  about  ten  freezings  were  necessary  to  effect  a 
permanent  cure.  These  patients  often  suffer  a  relapse, 
especially  in  inclement  weather,  but  a  single  freezing 
suffices  to  cure.  My  only  excuse  for  citing  the  latter  case  is 
to  illustrate  the  frequency  of  pseudovisceral  affections  which 
are  often  erroneously  interpreted  by  some  of  the  best  men 
in  the  profession.  Verily,  if  the  surgeon  were  a  better 
diagnostician  there  would  be  less  surgery. 

PSEUDO -CEREBRAL  DISEASE. 

When  a  neuralgia  implicates  respectively  the  four  superior 
cervical  nerves,  it  is  referred  to  as  cervico-occipital  neuralgia 
and  the  four  inferior  cervical  nerves,  as  a  cervico-brachial 

192 


P  s   e   u    do    -    Mastoiditis 

neuralgia.  In  the  former  neuralgia,  the  major  occipital 
nerve  is  most  frequently  involved  and  the  pain  is  located  in 
the  neck  and  radiates  along  the  occipital  region  as  far  for- 
ward as  the  eyes.  There  is  practically  always  a  spasm  of  the 
cervical  muscles  which  interferes  with  the  elicitation  of  pain 
upon  deep  pressure  at  the  vertebral  exits  of  the  implicated 
nerve  or  nerves.  Not  infrequently,  branches  of  the  brachial 
plexus  are  similarly  involved  and  the  pains  radiate  down 
the  arms.  In  cervico -occipital  neuralgia,  localized  areas  of 
sensitiveness  may  be  detected  notably  at  the  external  occipital 
protuberance  and  at  the  tip  of  the  mastoid  process.  The 
latter  point  of  sensitiveness  has,  in  my  experience,  often  been 
mistaken  for  a  mastoiditis  by  enthusiastic  aurists,  yet  a 
single  freezing  at  the  verterbal  exits  of  the  involved  nerves 
will  determine  the  nature  of  such  forms  of  PSEUDO -MAS- 
TOIDITIS. Pseudo-mastoiditis  is  frequently  mistaken  for  the 
true  form  of  the  disease  if  a  discharge  from  the  ear  (otorrhea) 
is  present. 

When  the  pathologist  makes  an  autopsy  he  records  the 
many  pathological  conditions  as  anatomic  diagnoses.  The 
clinician  should  be  similarly  guided,  but,  unfortunately,  he 
too  often  errs  in  tracing  a  connection  between  varying 
symptoms  in  his  effort  to  include  them  all  in  a  single  diag- 
nosis. Co-existing  symptoms  may  be  the  expression  of  not 
only  one  but  of  several  distinct  diseases.  The  following  case 
will  amply  illustrate  the  author's  meaning:  A  gentleman 
having  fallen  from  a  ladder  sustained  an  injury  of  the  spinal 
column  which  resulted  in  a  kyphotic  deformity.  Several 
weeks  later  he  developed  atrocious  pains  in  his  right  leg 
which  several  orthopedists  attributed  to  the  original  injury. 
Examination  of  the  patient  in  question  demonstrated  a 
sciatica  which  had  absolutely  no  connection  with  the  primary 
traumatism  and  after  several  freezings  over  the  region  of 

193 


S  p    o     n    d    y    I    o    t    h    e    r    a    p    y 

the  nerve,  the  pains  subsided  completely  and  have  ceased 
to  reappear  after  several  years,  notwithstanding  the  per- 
sistence of  the  spinal  deformity. 

About  four  years  ago  one  of  my  tabetics  returned  from 
Europe  suffering  from  severe  pains  in  the  head  which  several 
specialists  had  told  him  were  dependent  on  a  cerebral  lesion. 
The  pains  resisted  conventional  treatment.  Examination  of 
the  patient,  who  returned  to  San  Francisco  in  despair  and 
without  relief,  demonstrated  the  presence  of  a  cervico- 
occipital  neuralgia.  The  localized  areas  of  sensitiveness  on 
his  scalp  disappeared  after  a  single  freezing  at  the  vertebral 
exits  of  the  involved  cervical  nerves  and  cure  resulted  after 
a  thorough  repetition  of  the  procedure. 

A  lady  with  pains  in  the  left  half  of  the  abdomen  con- 
sulted several  gynecologists,  all  of  whom  discovered  a  pro- 
lapsed ovary  and  suggested  its  removal.  The  pains  due  to  a 
lumbo -abdominal  neuralgia  continued  after  the  operation 
and  were  cured  after  several  freezings  at  the  exits  of  the 
involved  nerves. 

PSEUDO -ANGINA  PECTORIS 

An  intercostal  neuralgia  is  frequently  misinterpreted  for 
angina  pectoris.  In  the  latter  affection  pains' radiate  to  the 
neck  and  arm.  The  investigations  of  Head  and  Mackenzie 
show  the  following : 

1.  In  cardiac  and  aortic  disease,  the  pain  is  referred 
along  the  ist,  2nd  and  3rd  dorsal  nerves. 

2.  In  angina  pectoris,  the  pain  in  addition  may  be 
referred  from  the  5th  to  the  pth  dorsal  nerves. 

The  forms  of  anginal  pains  referred  to  in  this  connection 
are  not  concerned  with  functional  angina  pectoris  observed 
in  neuroses,  but  are  distinctly  traceable  to  a  neuralgia  of 
the  intercostal  nerves. 

194 


Pseudo-Arrhythmia 

About  fifteen  years  ago  an  elderly  individual  was  referred 
to  me  by  an  Eastern  physician  with  a  diagnosis  of  angina 
pectoris.  Several  prominent  clinicians  had  made  a  similar 
diagnosis.  Like  in  true  angina,  the  common  exciting  factor 
in  provoking  a  paroxysm  of  pain  in  this  patient  was  exposure 
to  cold.  Despite  the  concomitant  symptoms  which  suggested 
the  correctness  of  the  diagnosis,  the  patient  was  examined 
for  the  signs  of  intercostal  neuralgia  which  could  easily  be 
demonstrated.  A  few  freezings  at  the  vertebral  exits  of  the 
involved  nerves  sufficed  to  rid  the  patient  of  his  pains  which, 
up  to  the  time  of  writing,  have  not  recurred. 

PSEUDO -ARRHYTHMIA. 

An  irregular  heart  may  be  clinically  manifested  as  an 
intermission  when  one  or  more  beats  of  the  heart  are  dropped  r 
or,  as  an  irregularity,  when  the  beats  show  inequality  in 
volume  and  force.  The  causal  classification  of  Baumgarten 
is  as  follows: 

1.  Organic  cerebral  affections. 

2.  Reflex  from  visceral  diseases. 

3.  Toxic,  from  tobacco,  coffee,  tea  and  from  drugs  like 
digitalis,  belladonna  and  aconite. 

4.  Changes  in  the  heart. 

Arrhythmia  may  exist  for  a  long  period  without 
symptoms.  It  is  usually  in  connection  with  other  cardiac 
signs  that  its  presence  is  noted.  Associated  with  myocardial 
or  valvular  lesions  it  is  ominous,  but  as  a  permanent  con- 
dition, secondary  to  mental  influences,  it  is  usually  without 
significance.  Irregularity  of  the  heart-rhythm  may  give  no 
expression  in  the  pulse.  The  purely  neurogenic  type  of 
irregularity  observed  in  healthy  children  and  young  adults 
is  due  to  overaction  of  the  vagus.  When  the  latter  is  para- 
lyzed by  atropin  (grain  1-120  to  1-60),  the  pulse  becomes 

195 


Spondyloth     e     r    a    p    y 

regular.  Heart  intermittency  is  differentiated  from  simple 
irregularity,  by  the  fact,  that,  in  resumption  of  the  cardiac 
contractions  they  are  regular  from  the  beginning. 

The  author  has  demonstrated  that,  in  the  norm  during 
the  time  the  pulse  is  palpated,  firm  pressure  made  at  the  exit 
of  the  spinal  nerves  (preferably  at  the  sides  of  the  upper 
dorsal  vertebrae),  will  result  in  decided  alteration  in  the 
character  of  the  pulse  which  often  amounts  to  inhibition  of 
the  latter.  In  a  few  instances  a  decided  arrhythmia  may  be 
observed. 

The  observations  of  the  author  have  taught  him  that  a 
neuralgia  of  the  upper  intercostal  nerves  is  not  an  infrequent 
etiologic  factor  in  arrhythmia  notwithstanding  the  fact  that, 
this  cause  is  unrecognized  in  the  text-books. 

In  intercostal  neuralgia  associated  with  arrhythmia, 
pressure  on  the  sensitive  areas  corresponding  to  the  exits  of 
the  involved  nerves  will  accentuate  the  condition,  and,  if 
absent,  will  provoke  it. 

In  such  instances  of  arrhythmia,  a  single  freezing  at  the 
vertebral  exits  of  the  involved  nerves  will  often  arrest  the 
trouble  at  once.  Arrhythmia  may  also  exist  as  a  result  of  a 
nerve-root  lesion  of  the  upper  group  of  dorsal  nerves  without 
any  symptoms  of  intercostal  pains. 

PSEUDO  -ESOPHAGISMUS . 

The  following  case,  selected  from  many  cases  of  a  similar 
nature,  is  interesting  as  a  paradigm  of  this  condition.  The 
patient,  a  female,  has  suffered  for  months  in  consequence  of 
painful  deglutition  and  is  very  much  emaciated  in  conse- 
quence of  her  difficulty  in  swallowing  not  only  solid  foods, 
but  liquids.  An  examination  was  negative  beyond  pain  on 
pressure  in  the  cervical  region  with  sensitive  cervical  vertebras 
on  percussion.  There  were  no  symptoms  of  hysteria.  The 

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Pseudo-Visceral    Diseases 

dysphagia  disappeared  completely  after  three  applications 
of  the  freezing-spray  to  the  region  of  the  sensitive  cervical 
nerves. 

PSEUDO  -NEPHROLITHIASIS . 

The  patient,  a  physician,  had  suffered  for  many  years 
from  pains  in  the  lumbar  region  on  the  right  side  occurring  in 
paroxysms  and  simulating  the  pain  of  renal  colic.  An 
exploratory  incision  down  to  the  kidney  was  made  by  an 
eminent  surgeon  of  Philadelphia,  and  nothing  was  found. 
When  the  patient  came  to  me  his  pain  still  persisted.  The 
first  and  second  lumbar  vertebrae  were  sensitive  to  percussion 
and  areas  of  vertebral  sensitiveness  were  located  to  the  right 
of  the  spinal  column.  Successive  freezings  of  the  para- 
vertebral  area  of  sensitiveness  checked  the  painful  parox- 
ysms completely. 

PSEUDO  -DYSPEPSIA. 

There  are  many  cases  which  I  have  denominated  fictitious 
dyspepsia,  which  are  comparatively  frequent  and  are  asso- 
ciated with  involvement  of  the  spinal  nerves.  The  patients 
may  exhibit  all  the  symptoms  of  dyspepsia,  yet  the  presence 
of  the  painful  areas  of  sensitiveness  of  an  intercostal  neuralgia 
are  demonstrable.  These  cases,  like  the  others,  yield  to 
freezing.  • 

PSEUDO  -CHOLELITHIASIS . 

About  several  months  ago  several  surgeons  had  made  the 
diagnosis  of  gall-stones  in  an  adult  male,  who  for  several 
years  had  suffered  from  paroxysmal  pains  in  the  region  of 
the  gall-bladder.  Before  submitting  to  an  operation  he 
decided  to  consult  three  medical  clinicians.  We  also  con- 
curred in  the  diagnosis.  The  author  was  reluctant  to  question 
the  diagnosis  for  the  reason  that  the  severe  paroxysms  of 
pain  necessitated  the  use  of  morphine.  When  pain  is  severe 

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enough  to  necessitate  an  analgesic  so  powerful  as  morphine 
(in  the  author's  experience)  intercostal  neuralgia  can  be 
excluded.  On  the  following  day,  the  patient  in  question 
was  re-examined  and  the  areas  of  sensitiveness  peculiar  to 
intercostal  neuralgia  could  be  demonstrated.  About  ten 
freezings  over  the  vertebral  exits  of  the  implicated  nerves 
sufficed  to  completely  rid  the  patient  of  his  paroxysms  of 
pain.  In  fact,  after  the  first  freezing,  the  painful  area 
located  near  the  gall-bladder  was  no  longer  sensitive  to 
pressure. 

The  author  has  seen  a  number  of  such  cases  and  one  case 
in  particular  is  recalled,  where  jaundice  accompanied  the 
painful  paroxysms.  The  jaundice  in  the  latter  case  could 
be  explained  by  the  fact  that  respirations  on  the  affected 
side  were  limited.  It  is  well-known  that  the  bile  is  secreted 
under  very  low  pressure  and  that  the  diaphragm  in  contract- 
ing, subjects  the  liver  to  pressure  which  is  an  active  factor 
in  forcing  the  bile  from  the  smaller  to  the  larger  biliary 
ducts.  Interference  with  the  movements  of  the  diaphragm 
is  likely  to  cause  icterus  of  resorption. 

PSEUDO -MAMMARY  NEOPLASMS. 

As  before  remarked,  neuralgia  of  the  intercostal  nerves 
is  associated  with  a  circumscribed  tonic  spasm  of  muscle  and, 
if  the  neuralgia  involves  the  nerves  in  juxtaposition  to  the 
mamma,  the  pain  and  intumescence  suggest  a  neoplasm. 
In  such  instances,  an  error  is  unavoidable,  unless  the  phys- 
ician recalls  the  fact,  that  mastodynia  may  be  a  variety  of 
intercostal  neuralgia. 


198 


The      Heart      Reflex 


CHAPTER  VII. 

THE  CIRCULATORY  SYSTEM. 

THE  HEART  REFLEX — CARDIAC  SUFFICIENCY — DIFFERENTIAL  TABLE  OF 
ASTHMA — TESTS  FOR  HEART-SUFFICIENCY — ANGINA  PECTORIS — 
THE  HEART  REFLEX  OF  DILATATION — DIFFERENTIAL  TABLE  OF 
TRUE  AND  FALSE  ANGINA — FUNCTIONAL  AFFECTIONS  OF  THE 
HEART — INHIBITION  OF  THE  HEART — PHYSIOLOGY  AND  PATH- 
OLOGY OF  THE  BLOOD-VESSELS — BLOOD-PRESSURE — VASO-MOTOR 
FACTOR  IN  BLOOD-PRESSURE — SPHYGMOMANOMETRY — HYPERTEN- 
SION AND  HYPOTENSION — THE  AORTIC  REFLEXES — ANEURYSM  OF 
THE  THORACIC  AORTA — THE  VASO-MOTOR  APPARATUS — VASO-MOTOR 
NEUROSES. 

THE  HEART  REFLEX. 

A  TTENTION  was  first  directed  in  1898  to  the  phenom- 
•*•  enon52  now  known  as  the  heart  reflex  of  Abrams.  The 
reflex  in  question  is  a  contraction  of  the  myocardium  of 
varying  duration,  which  results  when  the  skin  of  the  pre- 
cordial  region  is  irritated.  The  cutaneous  irritant  may  be 
a  spray  of  ether  directed  over  the  region  of  the  heart,  or  the 
skin  may  be  rubbed  with  a  blunt  instrument,  or  by  means 
of  an  ordinary  pencil  eraser,  or  by  a  series  of  percussion 
blows.  The  nearer  the  irritant  is  applied  to  the  precordial 
region  and  the  more  vigorous  the  cutaneous  friction,  other 
things  being  equal,  the  more  pronounced  is  the  heart  reflex. 
The  reflex  is  best  observed  with  the  Roentgen  rays  with  the 
fluorescent  screen  approximating  the  anterior  chest-wall. 
The  reflex  is,  as  a  rule,  more  manifest  in  the  left  than  in  the 
right  ventricle,  and  the  contraction  of  the  myocardium  is 
not  always  sudden  and  of  momentary  duration;  on  the 
contrary*  its  duration  in  children,  on  whom  most  of  the 
original  observations  were  made,  is  not  less,  as  a  rule,  than 

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two  minutes,-  and,  furthermore,  the  myocardial  recession 
continues  even  after  the  source  of  cutaneous  irritation  is 
removed.  The  degree  of  myocardial  recession  (heart 
reflex)  varies  greatly.  In  some  persons  it  is  scarcely  percep- 
tible, while  in  other  individuals  the  heart  may  recede  more 
than  2  cm.  on  either  side  upon  the  first  application  of  the 
cutaneous  irritant  (Fig.  54).  * 


FIG.  54. — Heart  reflex  in  a  boy,  aged  eight  years.  Duration  of  reflex  two  and 
a  half  minutes.  The  normal  outline  of  the  heart  drawn  on  the  fluoroscope  is 
represented  by  A,  whereas  B  represents  the  outline  of  the  heart  after  cutaneous 
irritation  and  shows  the  degree  of  myocardial  recession  of  the  heart  reflex. 

In  other  instances,  although  the  reflex  is  practically  never 
absent  in  the  norm,  it  is  strictly  confined  to  the  left  ventricle, 
as  shown  in  Fig.  55. 

In  individuals  with  dilated  hearts  the  reflex  is  very 
evident  and  is  of  much  longer  duration  than  in  healthy  hearts. 
This  latter  observation,  as  we  shall  learn  presently,  has  been 
confirmed  by  the  careful  observations  of  Merklen  and  Heitz. 

In  the  original  communications  concerning  the  heart 

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art      Reflex 


reflex,  the  latter  was  only  observed  in  the  transverse  cardiac 
diameter,  but  with  the  x-rays  it  can  also  be  seen  in  the 
sagittal  diameter.  Subsequent  observations  demonstrated 
that  the  heart  reflex  could  be  elicited  by  irritation  of  more 
remote  regions,  viz. : 

1.  Irritation  of  the  nasal  mucosa. 

2.  Irritation  of  the  gastric  mucous  membrane. 

3.  Irritation  of  the  rectal  mucosa. 

4.  By  irritation  of  the  esophageal  mucosa  in  the  act  of 
swallowing. 

5.  By  percussion  of  the  muscles. 

6.  By  psychic  influences. 

7.  By  vertebral  concussion. 


FIG.  55. — Heart  reflex  in  a  boy,  aged  fourteen  years.  Duration  of  reflex,  fifteen 
seconds.  A  represents  the  cardiac  outline  before,  and  B  after,  cutaneous  irritation, 
while  C  represents  the  upper  border  of  the  liver. 

IRRITATION  OF  MUCOUS  MEMBRANES. — Here  investiga- 
tions were  conducted  during  the  time  the  x-rays  were  tra- 
versing the  chest,  and  by  means  of  the  fluoroscope  the 
heart  was  directly  observed.  It  was  noted  that,  when  irri- 
tating vapors  were  inhaled  there  was  a  decided  recession  of 
the  cardiac  ventricles  (heart  reflex),  especially  the  left,  and 
that  this  heart  reflex  was  more  pronounced  than  when 

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S    p     o    n    d    y    I    o    therapy 

excited  through  the  skin  of  the  precordium.  Ether  and 
chloroform  inhalations  also  excite  the  reflex  and  in  a  few 
instances,  these  vapors  produced  a  veritable  cardiac  in- 
hibition. It  was  noted  that,  the  reflex  in  question  was  excited 
by  irritation  in  succession  of  the  nasal,  pharyngeal  and 
laryngeal  mucous  membranes,  and  when  the  latter  were  made 
anesthetic  by  cocain,  no  heart  reflex  could  be  elicited. 

The  accompanying  sphygmogram  (Fig.  56)  shows  a 
decided  difference  in  the  output  into  the  general  circulation 
before  and  after  the  inhalation  of  ammonia. 

The  heart  reflex  may  also  be  elicited  by  irritation  of  the 
gastric  mucosa  when  the  sponge  of  the  gyromele  is  made  to 


FIG.  56. — Sphygmogram  of  the  radial  artery ;  A  before,  and  B  after,  the  in- 
halation of  ammonia. 


revolve  against  the  membrane  in  question.  One  may  also 
excite  the  reflex  by  irritation  of  the  rectal  mucosa  by  means 
of  the  finger  in  the  rectum. 

PERCUSSION  OF  THE  MUSCLES. — If  one  percusses  the 
muscles  (tapotement}  of  the  extremities,  one  can  elicit  the 
cardiac  reflex.  The  latter  is  essentially  a  reflex  of  muscular 
origin  exclusively,  as  such  a  reaction  does  not  follow  irritation 
of  the  skin  of  the  extremities  or  percussion  of  the  bones. 
Percussion  of  the  muscles  of  one  arm  usually  suffices  to 
elicit  this  reflex.  Another  curious  feature  of  this  myopathic 
heart  reflex  is,  that  it  causes  contraction  of  the  right  ventricle 
of  the  heart  only,  the  left  being  uninfluenced.  Placing  the 
subject  before  the  x-rays,  this  reflex  is  at  once  evident. 
After  the  borders  of  the  heart  are  defined,  request  an  assistant 

202 


The      Heart     Reflex 

to  percuss  the  muscles  of  one  arm  by  means  of  a  percussion  - 
hammer.  Following  the  manosuver  the  right  ventricle  shows 
considerable  retraction.  The  effect  on  the  systemic  blood- 
pressure  by  percussion  of  the  muscles  is  very  slight,  and 
this  is  obvious,  considering  that  the  left  heart -ventricle  is 
uninfluenced  by  the  manoeuver. 

PSYCHIC  INFLUENCES. — We  have  always  recognized  the 
influence  of  emotions  on  the  heart,  but  no  tangible  evidence 
of  such  effects  has  been  demonstrated.  The  epigram  of 
Peter  is  worth  repetition :  "The  physical  heart  is  the  counter- 
part of  a  moral  heart."  The  conventional  expression  of  the 
frightened  individual,  "My  heart  was  in  my  mouth,"  finds 
justification  by  an  x-ray  study  of  the  organ.  Inform  the 
patient  standing  before  the  x-rays,  that  you  are  going  to 
burn  him  with  a  hot  iron  or  frighten  him  in  some  other  way, 
and  the  effect  on  the  heart  is  at  once  manifested.  It  is  a 
veritable  psychic  heart  reflex  implicating  the  entire  organ. 
The  heart  becomes  very  much  reduced  in  size,  and  appears 
as  if  it  were  retreating  towards  the  neck.  I  know  of  no 
irritation,  cutaneous  or  otherwise,  that  is  so  pronounced  as 
this  psychic  factor  of  fright  in  inducing  the  heart  reflex.  The 
foregoing  fact  is  of  the  utmost  importance  in  eliminating 
emotional  influences  in  the  treatment  of  cardiac  diseases. 
Even  in  an  ordinary  x-ray  examination  of  the  heart,  one 
may  observe  in  nervous  patients  a  reduction  of  the  heart- 
mass.  Mr.  Bezley  Thorne53  observed  that  the  heart  shrank 
after  exposure  to  the  Roentgen  rays.  It  is  evident  that  the 
shrinkage  thus  observed,  was  naught  else  but  a  cardiac  re- 
action (heart  reflex)  to  emotional  influences,  for  an  x-ray 
examination  to  the  average  patient  is  a  momentous  procedure. 

The  author  has  frequently  witnessed  the  pulmonary 
reaction  of  fright ;  the  lungs  became  hyperresonant  on  per- 
cussion and  the  superficial  areas  of  cardiac,  hepatic  and 

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S    p     o    n    d    y    I    o     therapy 

splenic  dullness  became  diminished,  a  condition  which  the 
author  has  called  the  psychic  lung  reflex  of  dilatation.  The 
latter  psychic  reflex  may  be  easily  demonstrated,  if  the 
areas  of  the  organs  in  question  are  first  outlined,  and  later, 
if  the  patient  is  frightened,  percussion  will  demonstrate  that 
the  areas  of  the  organ  are  reduced  in  proportion  to  the  psychic 
reaction  which  provokes  a  dilatation  of  the  lungs. 

VERTEBRAL  CONCUSSION. — Perhaps  the  most  effective 
method  of  provoking  the  heart  reflex  is  by  means  of  con- 
cussion of  the  spinous  process  of  the  yth  cervical  vertebra. 
It  will  be  noted  that  this  refers  to  the  heart  reflex  of  con- 
traction, for  there  is  still  another  heart  reflex  which  is  to  be 
described  presently,  known  as  the  heart  reflex  of  dilatation. 

PRACTICAL  VALUE  OF  THE  HEART  REFLEX. — Percussion  of 
heart,  or,  for  that  matter,  any  other  organ  adjacent  to  the 
lung,  is  associated  with  many  errors  unless  one  takes  into 
consideration  the  lung  reflex. 

Percussion  of  the  heart,  as  executed  ordinarily,  yields  an 
absolute  or  superficial,  and  a  deep  or  relative  dullness. 
Practically  little  or  no  value  can  be  attached  to  the  superficial 
dullness  in  estimating  the  size  of  the  heart,  as  it  varies  with 
the  position  of  the  overlapping  lung-borders.  Even  the 
lightest  percussion  blow  will  provoke  sufficient  cutaneous 
irritation  to  induce  the  lung  reflex  of  dilatation,  i.e.,  an  acute 
dilatation  of  the  lungs  which  may  diminish  the  area  of 
superficial  cardiac  dullness,  even  to  obliteration.  Cabot,54 
in  his  classical  book,  makes  the  following  observation :  "Any- 
one who  has  demonstrated  an  area  of  percussion  dullness  to 
many  students  in  succession  must  have  noticed  occasionally 
that  the  more  we  percuss  the  dull  area  the  more  resonant  it 
becomes,  so  that  those  who  last  listen  to  the  demonstration, 
the  difference  which  we  wish  to  bring  out  is  much  less 
obvious  than  to  those  who  heard  the  earliest  percussion 

204 


The     Heart     Reflex 

strokes.  Abrams  has  referred  to  this  fact  under  the  name  of 
the  'lung  reflex.' '  Sahli,  in  his  "Diagnostic  Methods," 
refers  to  the  same  fact.  The  mere  influence  of  room  tem- 
perature materially  changes  the  results  of  percussion.  Let 
any  one,  after  percussing  the  areas  of  superficial  dullness, 
direct  a  current  of  cold  air,  e.g.,  from  an  atomizer,  over  the 
regions  percussed,  and  the  result  will  be  diminution  or 
obliteration  of  the  areas  in  question.  It  is  evident  from  what 
has  preceded  that,  while  the  heart  reflex  can  always  be 
determined  by  the  x-rays,  after  cutaneous  irritation  of  the 
precordium,  mere  percussion  of  the  superficial  area  of  cardiac 
dullness  cannot  determine  its  existence  because  the  irritation 
necessary  to  evoke  the  heart  reflex  will  also  induce  the  lung 
reflex,  which  must  necessarily  mask  the  heart  reflex. 

Thus  the  observations  of  Schott  and  others,  who  seek  to 
demonstrate  the  effects  of  carbonated  baths  on  the  heart  by 
percussion  of  the  latter  organ  are  evidently  erroneous  unless 
such  percussion  takes  into  consideration  only  the  deep  or 
relative  cardiac  dullness.  Heitler56 perpetrates  the  same  error 
by  failing  to  take  into  consideration  the  coincident  lung 
reflex  when  making  cutaneous  irritation.  Heitler  seeks  to 
determine  the  sufficiency  of  the  heart  muscle  by  a  series  of 
percussion  blows  over  the 'heart  region.  If,  thereafter,  the 
cardiac  dullness  is  much  diminished,  it  is  an  evidence,  he 
argues,  that  the  cardiac  musculature  is  sufficient,  for  the 
tendency  of  the  normal  muscle  tonus  of  the  heart  is  to 
maintain  a  limited  patch  of  dullness.  As  before  remarked, 
the  heart  reflex  can  be  observed  directly  with  the  rays,  but 
if  strong  percussion  is  employed  so  that  reliance  is  alone 
placed  on  the  deep  or  relative  cardiac  dullness,  the  reflex  in 
question  may  be  determined  by  percussion.  Heitz,57  in 
discussing  "Le  Reflexe  Cardiaque  d'Abrams,"  observes  that, 
while  in  the  normal  subject  the  heart  reflex  is  of  short  dura- 

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tion,  in  cardiectasis  it  may  persist  for  several  hours.  In  the 
third  edition  of  their  valuable  book  ("Examen  et  Semeiotique 
du  Cceur"),  Merklen  and  Heitz  show  graphically  the  effects 


© 


V 


FIG.  57. — Cardiac  reflex  in  a  neurasthenic  with  functional  troubles  of  the 
heart;  reduction  of  the  absolute  and  relative  dullness.     (After  Merklen  and  Heitz). 

of  friction  of  the  skin  in  the  region  of  the  heart  of  a  cardiac 
neurasthenic  (Fig.  57),  and  in  a  cardiopath  with  hyposystolie 
(Fig.  58). 


© 


FIG.  58. — Hyposystolie  in  an  arteriosclerotic;  reduction  of  the  absolute  and 
relative  cardiac  dullness  and  ascension  of  the  inferior  border  of  the  liver  under 
the  influence  of  precardial  massage.  (After  Merklen  and  Heitz). 

In  Fig.  58  the  reduction  of  the  hepatic  dullness  is  shown 
following  the  friction  of  the  skin ;  the  continuous  lines  show 
the  superficial  and  the  deep  dullness  of  the  heart  before,  and 
the  interrupted  lines  the  reduction  of  the  areas  after  friction 
of  the  skin. 

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The      Heart     Reflex 

All  physicians  do  not  possess  equal  skill  in  determining 
the  relative  cardiac  dullness,  and  I  have  devised  a  simple 
apparatus  called  the  "Vibrosuppressor,"  which  serves  to 
simplify  topographical  percussion  (page  80). 

The  Heart  Reflex  of  Nasal  Genesis. — Reference  has  al- 
ready been  made  to  the  fact  that  the  heart  reflex  can  be 
provoked  by  irritation  of  the  nasal,  pharyngeal,  and  laryngeal 
mucous  membranes,  and  that  if  the  irritation  is  sufficiently 
prolonged  and  violent  the  movements  of  the  heart  may  be 
inhibited.  If  the  membranes  in  question  have  been  previously 
cocainized  the  heart  reflex  cannot  be  elicited.  It  is  evident, 
then,  that  previous  cocainization  of  the  nasal  and  pharyngeal 
mucous  membranes  should  precede  the  employment  of  an 
anesthetic.  On  theoretical  grounds,  the  laryngeal  mucosa 
should  not  be  cocainized,  as  it  is  necessary  to  preserve  the 
laryngeal  reflex  to  prevent  the  entrance  of  foreign  substances 
into  the  larynx. 

The  Heart  Reflex  of  Gastric  Genesis. — Knowing  that 
irritation  of  the  gastric  mucosa  will  provoke  the  heart  reflex, 
it  is  not  improbable  that  sudden  death  of  gastric  origin  may 
be  caused  by  refljex  inhibition  of  the  heart.  In  instances  of 
this  kind  the  fact  of  a  dilated  stomach  directly  compressing 
the  heart  cannot  be  ignored.  I  have  studied,  by  aid  of  the 
x-rays  and  the  fluoroscope,  the  action  of  a  dilated  stomach 
on  the  heart  by  artificial  distension  of  the  stomach.  The 
healthy  heart  can  tolerate  considerable  compression  and  dis- 
location without  modifying  the  intensity  of  the  heart  tones, 
but  when  the  organ  is  diseased,  the  slightest  compression 
and  dislocation  is  followed  by  evil  consequences.  Artificial 
insufflation  of  the  colon  will  also  compress  and  dislocate  the 
heart,  but  never  in  the  same  degree  as  will  insufflation  of 
the  stomach  (Fig.  33). 

The  Heart  Reflex  of  Rectal  Origin. — Irritation  of  the 

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Spondyloth     e    r    a   p    y 

rectal  mucosa  will  also  induce  the  heart  reflex.  Straining  at 
stool  in  elderly  people  by  increasing  intraabdominal  pressure, 
and  thus  putting  a  strain  on  the  cerebral  vessels,  predisposes 
to  rupture  of  the  latter.  Straining,  however,  is  not  wholly  a 
question  of  pressure.  Some  patients,  particularly  those  with 
weak  hearts,  suffer  from  collapse  symptoms  while  straining 
at  stool.  In  investigating  the  cause  of  such  symptoms,  I  found 
that  contraction  of  the  abdominal  musculature  will  cause 
even  in  the  norm  a  veritable  weak  heart  reflex  with  diminished 
output  of  blood  from  the  left  ventricle.  For  the  latter  reason 
the  amount  of  blood  is  decreased  in  the  arterial  system  and 


FIG.  59. — Sphygmogram  (A)  before  and  (B)  while  straining  at  stool. 

increased  in  the  veins.  The  accompanying  sphygmogram 
(Fig.  59)  illustrates  the  effects  of  contraction  of  the  abdom- 
inal musculature  on  the  heart. 

It  is  evident  that  if  the  heart  is  enfeebled  the  effects  of 
such  cardiac  inhibition  may  be  attended  with  serious  results. 
It  is  well  known  that  different  nerves  from  the  abdomen  and 
intestine  are  in  close  communication  with  the  cardioin- 
hibitory  center  in  the  medulla  and  that  reflex  inhibition  of 
the  heart  can  be  easily  produced  in  the  frog  by  tapping  a  loop 
of  the  intestine  with  the  handle  of  a  scalpel.  Severe  abdom- 
minal  affections,  like  peritonitis  and  appendicitis,  are 
frequently  attended  with  symptoms  of  heart  collapse,  owing, 
no  doubt,  to  reflex  inhibition  of  the  heart. 

Anyone  can  appreciate  the  inhibitory  influence  on  the 

208 


Heart       R      e      f     I 


x 


heart  if  the  radial  pulse  is  palpated  during  contraction  of 
the  abdominal  muscles  while  straining  at  stool. 

Relative  Valvular  Insufficiency. — The  normal  heart  can 
easily  adapt  itself  to  the  average  grades  of  dilatation  such  as 
occur  during  exertion ;  in  fact,  the  size  of  the  cavities  of  the 
heart  varies  even  in  health,  and  a  dilatation  is  physiologic 
as  long  as  the  heart  cavity  is  capable  of  emptying  its  contents 
during  systole.  What  is  called  "getting  wind"  in  climbing 
a  mountain  or  in  athletic  training  is  practically  a  moderate 
dilatation  of  the  cavities  of  the  right  heart.  In  relative 
valvular  insufficiency  the  valves  are  normal,  but  they  are  no 
longer  capable  of  completely  closing  the  orifices  of  the  heart. 
This  condition  is  frequent  after  heart  strain  and  involves 
particularly  the  tricuspid  valves.  A  murmur  which  is  heard 
in  such  instances  may  be  made  to  disappear  temporarily  by 
inducing  the  heart  reflex,  which,  by  causing  myocardial  con- 
traction, reduces  the  size  of  the  cardiac  orifices,  thus  enabling 
the  valves  to  close  the  openings.  Here  the  excitant  of  the 
heart  reflex  must  be  vigorous  and  for  this  purpose  the  sinu- 
soidal current,  with  both  electrodes  to  the  precordial  region, 
is  most  efficacious.  Percussion  of  the  precordial  region  with 
a  percussion  hammer  will  often  suffice. 

Pericardial  Effusion. — The  differential  diagnosis  between 
a  dilated  heart  and  a  pericardial  effusion  is  often  conceded 
to  be  a  difficult  clinical  problem.  From  what  has  preceded 
the  heart  reflex  can  be  employed  in  diagnosis.  The  reflex  in 
question  is  absent  in  pericardial  effusions  and  present  in 
cardiectasis.  In  other  words,  after  the  heart  reflex  is  pro- 
voked the  area  of  deep  cardiac  dullness  will  be  uninfluenced 
in  effusions  but  modified  in  cardiectasis. 

It  may  be  difficult  to  say  whether  a  pulsating  intra- 
thoracic  mass  examined  with  the  x-rays  is  the  heart  or  an 
aneurysm.  A  retraction  of  the  mass  after  provoking  the 

209 


S   p     ondyloth     e     r    a    p    y 

heart  reflex  would  indicate  that  it  is  the  heart  and  not  an 
aneurysm.  Cooper  utilized  the  foregoing  fact  in  differential 
diagnosis.  I  will  not  now  attempt  to  discuss  the  therapeutic 
value  of  the  heart  reflex,  but  it  is  my  personal  opinion  that 
the  carbonated  baths  in  the  Schott  treatment  possess  no 
special  effect  beyond  their  action  in  provoking  the  heart 
reflex  by  cutaneous  irritation  and  that  cutaneous  friction  by 
any  other  method  is  equally  efficacious.  The  foregoing  con- 
clusion is  formulated  only  as  a  result  of  many  years  of  obser- 
vation. Massage  of  the  precordial  region  or  the  employment 
of  the  sinusoidal  current,  especially  in  cardiopaths,  will 
reduce  the  area  of  the  heart  and  the  pulse -rate  and  augment 
blood -pressure.  The  now  prevailing  fetish  in  cardiothera- 
peutics  is  Nauheim.  I  subscribe  equally  to  the  efficiency  and 
deficiency  of  this  famous  resort,  but  it  is  puerile  to  endow 
its  waters  with  marvelous  attributes. 

CARDIAC  INSUFFICIENCY. 

-  One  frequently  observes  in  a  large  number  of  individuals 
at  about  the  period  of  middle-age,  definite  signs  of  cardio- 
vascular disturbances  even  though  no  valvular  lesions  are 
present.  Here  the  condition  is  due  to  some  change  in  the 
heart -muscle  which  has  not  been  definitely  established  even 
by  the  microscopist.  This  condition  has  been  popularly 
designated  as  heart-failure  or  heart-weakness,  and  others 
speak  of  the  condition  as  chronic  .cardiac  insufficiency  or 
incompetency. 

The  signs  of  incompensation  vary  according  to  whether  they 
are  caused  by  a  lesion  of  the  valves  or  occur  independently 
of  the  latter  and  are  dependent  on  changes  in  the  myocardium. 
All  diseases  of  the  heart,  whether  of  the  valves  or  myocardium, 
lead  eventually  to  disturbances  of  circulation.  The  phe- 
nomena associated  with  the  latter  are  easier  of  interpretation 
if  we  study  the  effects  of  valvular  lesions. 

210 


Cardiac    Insufficiency 

The  compensatory  mechanism  of  the  heart  illustrates 
why  cardio- vascular  disease  is  not  at  once  followed  by  dis- 
turbances in  the  circulation.  The  normal  heart  can  easily 
adapt  itself  to  the  average  grades  of  dilatation  such  as 
occur  during  exercise.  In  fact,  the  size  of  the  cavities  of 
the  heart  varies  even  in  health,  and  a  dilatation  is  physiologic 
as  long  as  the  heart-chamber  is  capable  of  emptying  its 
contents  during  systole.  Any  increased  work  on  the  part 
of  the  heart,  if  continued,  leads  to  an  increase  in  the  size 
and  number  of  the  muscle -fibers,  a  condition  known  as 
hypertrophy,  .which  enables  the  organ  to  contend  with  ad- 
ditional burdens. 

Although  a  valve-lesion  may  be  of  some  significance  in 
prognosis,  yet  the  essential  factor  always  is  the  question  of 
compensation. 

Valvular  lesions  are  of  two  kinds,  narrowing  of  the  valve- 
openings  (stenosis),  and  incomplete  closure  of  the  orifices 
(incompetency  or  regurgitation)  due  to  retraction  of  the 
valves.  In  either  condition  dilatation  of  one  of  the  chambers 
of  the  heart  occurs  because  it  is  always  distended  with  blood, 
and  incompletely  discharges  its  contents  at  systole.  When 
the  heart  hypertrophies,  to  overcome  the  latter  defect,  and 
thus  prevents  stasis  in  any  part  of  the  blood-current,  the  lesion 
is  compensated.  Thus  compensation  is  practically  dependent 
on  the  condition  of  the  heart-muscle.  If  the  heart  fails  to 
hypertrophy,  or  if  the  latter  has  occurred  and  it  is  subjected 
to  burdens  beyond  its  capacity,  or  in  consequence  of  degen- 
erative changes,  the  heart  fails  as  a  motor  and  it  becomes 
insufficient,  or,  as  is  often  said,  compensation  is  broken  or 
ruptured.  In  consequence  of  incompetence,  a  diminished 
quantity  of  blood  is  pumped  into  the  arterial  system,  hence 
the  arterial  pressure  is  decreased,  venous  pressure  is  increased 
and  the  current  of  the  blood  in  the  capillaries  is  retarded. 

211 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

The  cavities  of  the  ventricles  dilate  because  they  cannot 
discharge  their  contents  (increased  area  of  cardiac  dullness). 
Overloading  of  the  veins  conduces  to  the  collection  of  fluid 
in  the  tissues  which  begins  primarily  in  the  feet  and  gradually 
invades  the  other  parts  of  the  body. 

Cyanosis  of  the  skin  is  an  early  symptom  and  appears  as 
soon  as  there  is  a  disturbance  in  the  pulmonic  circulation. 

In  children,  a  lesion  of  a  valve  retards  development  and 
nutrition  and  produces  a  condition  known  as  cardiac  cachexia. 

The  pulse  is  often  characterized  by  intermittency  and  is 
caused  by  feeble  contractions  of  the  heart  which  are  not 
strong  enough  to  drive  the  blood  to  the  radial  artery.  In 
such  instances,  if  the  heart  is  auscultated  synchronously  with 
palpation  of  the  pulse,  there  are  more  heart -tones  than 
pulse-beats. 

DYSPNEA  in  disease  of  the  heart  is  out  of  all  proportion 
to  the  physical  changes  in  the  lungs  and  is  caused  by  pressure 
of  the  enlarged  heart  on  the  lungs,  disturbed  pulmonic  cir- 
culation, hydrothorax,  ascites,  or  bronchial  catarrh. 

CARDIAC  ASTHMA  may  be  confounded  with  asthma  of 
bronchial  origin  and  the  following  table  will  assist  in  differ- 
ential diagnosis : 

DIFFERENTIAL  TABLE  OF  ASTHMA. 
CARDIAC  ASTHMA.  BRONCHIAL  ASTHMA. 

Signs  of  cardiac  disease.  Usually  absent. 

Dyspnea  is  equally  inspiratory  and     Dyspnea  is  expiratory. 

expiratory. 
Pulse  in  the  early  stage  of  parox-     Pulse-tension     usually  increased 

ysm  may  be  strong,  but  it  soon         throughout  the  paroxysm. 

becomes  soft  and  small. 
Percussion  shows  an  extension  of     Extension  of  lung-borders  more 

the   borders  of  the   lungs  and         pronounced. 

obliteration  of  the  area  of  super-  / 

ficial  cardiac  dullness. 

212 


c 


a  r  d  i  a  c      I  n  s  u  f  f  i  c  i  e  n  c  y 


CARDIAC  ASTHMA. 

Auscultation  shows  an  absence  of 
rales  unless  complicated  by  lung- 
edema. 

Tracheal  traction-test  is  positive.* 

Cardiac  stimulation  will  inhibit 
attacks  and  cardiotonic  medica- 
tion will  prevent  them. 

Tests  show  cardiac  insufficiency 
(page  215). 


Concussion  of  the  ;th  cervical  ver- 
tebra may  arrest  an  attack  at 
once  by  provoking  the  heart  re- 
flex (page  199). 


BRONCHIAL  ASTHMA. 

Sonorous  and  sibilant  rales  are 
always  heard  and  are  loudest 
during  expiration. 

Tracheal  traction-test,  negative. 

No  special  results  from  cardiac 
stimulation. 

No  cardiac  insufficiency  unless 
heart-weakness  exists  as  a  com- 
plication, and  then  the  right 
heart  is  usually  compromised. 

Very  frequently  the  attack  can  be 
subdued  by  concussion  of  the 
4th  and  5th  cervical  vertebrae 
(page  313). 


Cardiac  insufficiency  due  to  myocardial  disease  may  be 
divided  into  three  main  groups,  which  are  as  follows : 

1.  An  arrhythmic  form,  in  which  the  pulse  is  irregular 

and  intermittent  and  lacks  force  and  volume. 

2.  A  group  characterized  by  acceleration  of  the  pulse 

(tachycardia)  and  paroxysms  of  palpitation. 

3.  An    asthmatic   group,    which    is    characterized    by 

attacks   of   acute   pulmonary   edema   and   cardiac 
asthma. 

Usually  the  patients  are  middle-aged  men  of  strong 
physique  who  have  eaten  to  excess  and  have  taken  very  little 
exercise. 

The  frontier  symptoms  of  cardiac  incompetency  in  such 

*The  author  has  described  this  test  as  an  aid  in  the  diagnosis  of  idiopathic  asthma. ?0 
When  the  head  of  a  patient  is  thrown  forcibly  backward,  the  normal  resonance 
obtained  by  percussion  over  the  manubrium  sterni  and  lungs  contiguous 
thereto  becomes  converted  into  a  dull  or  flat  sound.  This  manceuver  is  the 
tracheal  traction-test.  It  is  positive  in  health  and  in  all  cardiopulmonary 
affections,  excepting  in  idiopathic  asthma.  In  other  words,  in  the  latter 
affection,  the  pulmonary  resonance  over  the  manubrium  is  unchanged  when 
the  head  is  thrown  backward.  The  explanation  of  this  phenomenon  is  dis- 
cussed on  page  311. 

213 


S   p     o    n    d    y    I    o     t    h     e     r    a   p    y 

individuals  are  slight  difficulty  in  breathing  on  exertion  in 
ascending  stairs  and  in  walking  up  a  slight  hill.  The  in- 
dividual may  observe  that,  after  a  hearty  meal  there  is  a 
feeling  of  uneasiness  or  a  dull  pain  in  the  region  of  the 
heart.  These  symptoms  continue  to  become  more  pronounced 
and  are  not  infrequently  associated  with  attacks  of  fluttering 
or  palpitation  of  the  heart. 

One  may  also  observe  in  these  cases  signs  of  arter- 
iosclerosis. 

Percussion  shows  as  a  rule  an  increase  in  the  area  of 
cardiac  dullness  which  may  involve  either  ventricle  or  both. 

Respecting  the  prognosis  in  cases  of  cardiac  insufficiency, 
it  is  usual  to  regard  the  cases  as  hopeless  and  that  little  can 
be  done  to  patch  up  the  crippled  heart. 

The  author,  however,  finds  that  provided  a  good  heart 
reflex  can  be  obtained,  the  prognosis  is,  as  a  rule,  favorable. 
In  this  regard  one  may  cite  the  observations  of  Heitz  who 
shows  that,  the  heart  reflex  of  Abrams  is  a  good  guide  by 
which  to  determine  the  probable  effect  of  contemplated 
balneologic  treatment.  If  the  size  of  the  heart  does  not 
change  under  the  excitation  of  the  reflex,  by  sharp  blows 
over  the  precordial  region,  the  treatment  will  be  ineffectual 
or  may  even  be  contra-indicated  on  account  of  the  probable 
development  of  cyanosis.  In  very  large  dilatations  and  in 
advanced  myocardial  degeneration,  the  heart  does  not 
respond  to  precordial  excitation  and  is  not  favorably  in- 
fluenced by  baths.  If  the  reaction  is  feeble,  good  results  may 
be  achieved,  but  the  treatments  must  be  used  cautiously. 
Since  the  author  has  employed  concussion  of  the  spine  of 
the  yth  cervical  vertebra  for  provoking  the  heart  reflex, 
decidedly  better  results  can  be  achieved  from  treatment  than 
by  mere  precordial  excitation  which  has  heretofore  been 
practiced. 

214 


He    a    rt-Suffic    i    e    n    c    y 

It  may  be  remarked,  that  while  the  x-rays  furnish  the 
best  proof  of  the  amplitude  of  the  heart  reflex,  yet  results 
may  be  achieved  by  percussion,  if  the  vibrosuppressor  is 
employed  as  an  aid  (page  80).  Here  one  percusses  the 
heart  to  obtain  the  deep  or  relative  cardiac  dullness  and  the 
limitations  of  the  organ  are  carefully  marked  with  a  pencil. 
Next,  one  rubs  vigorously  the  skin  over  the  region  of  the 
heart,  or,  better  still,  one  strikes  a  series  of  concussion -blows 
upon  the  spinous  process  of  the  yth  cervical  vertebra  and 
percussion  of  the  heart  is  again  executed ;  any  diminution  in 
the  area  of  cardiac  dullness  indicates  the  amplitude  of  the 
heart  reflex. 

TESTS  FOR  HEART-SUFFICIENCY. 

In  disease  of  an  organ,  the  severity  of  a  lesion  is  generally 
gauged  by  the  incapacity  of  the  organ  to  execute  its  functions. 
Thus  it  is,  that  in  affections  of  the  kidney,  the  percentage 
of  albumin  in  the  urine  is  of  minor  prognostic  importance, 
provided  the  nitrogenous  excretion  is  relatively  normal. 

Similarly,  in  affections  of  the  heart,  a  murmur  is  of  no 
value  in  determining  the  prognosis  of  any  given  case,  inso- 
much as  some  of  the  most  serious  affections  of  the  heart  are 
unaccompanied  by  murmurs. 

In  the  presence  of  a  cardiac  disease,  whether  of  the  valves 
or  of  the  muscle  of  the  heart  (myocardium),  it  should  be 
the  primary  endeavor  of  the  physician  to  determine  the 
functional  capacity  of  the  organ.  Many  functional  diseases 
of  the  heart,  described  as  cardiac  neuroses  are  mere  instances 
of  heart-fatigue,  for  the  heart  like  the  skeletal  muscles  will 
tire  when  an  additional  burden  is  cast  upon  it;  in  fact,  the 
heart  may  be  the  most  vulnerable  muscle  in  exhaustion. 

We  have  already  noted  (page  203)  the  effects  of  emotions 
on  the  heart  and  among  neurasthenics,  emotional  influences 

215 


S    p     o     n     d    y    I    o     t    h     e     r    a    p    y 

must  be  regarded  as  additional  etiologic  factors  in  super- 
inducing heart -fatigue. 

There  are  many  individuals,  notably  women,  labeled  as 
neurasthenics,  who  are  really  sufferers  from  cardiac  incom- 
pensation. 

To  determine  the  vigor  of  the  myocardium,  the  conven- 
tional physical  methods  of  examination  furnish  little  practical 
aid,  hence  recourse  is  had  to  any  of  the  following  manceuvers : 

1.  THE  PULSE  METHOD. — The  pulse  of  the  cardiopath 
is  altered  in  character  after  body-movements  and  physical 
exertion  in  a  more  pronounced  manner  than  in  health,  and 
such  alteration  is  in  proportion  to  the  insufficiency  of  the 
heart -muscle.    When  the  heart  is  healthy  and  one  counts 
the  pulse  first  in  the  erect  and  again  in  the  recumbent 
posture,  a  retardation  of  the  pulse  in  the  latter  position  from 
10  to  12  beats  per  minute  is  observed.     In  disease  of  the 
heart-muscle,    however,    retardation   of   the   pulse   in   the 
recumbent  posture  becomes  less  and  less  conspicuous,  the 
greater  the  degree  of  cardiac  insufficiency,  until  in  pro- 
nounced grades  of  the  latter,  the  frequency  of  the  pulse 
may  even  be  greater  in  the  recumbent  than  in  the  erect 
posture. 

2.  BLOOD-PRESSURE  METHOD. — This  method  (like  the 
two  following  methods)  requires  the  use  of  a  blood -pressure 
instrument   (sphygmomanometer,  page  244).     It  is  known 
that  muscular  work  is  associated  with  alterations  in  the 
arterial  blood -pressure.     In  health  muscular  exertion  in- 
creases the  blood -pressure,  but,  if  the  heart  is  insufficient, 
this  rule  is  reversed,  viz.,  muscular  exertion  will  reduce  the 
blood -pressure.    The  less  evident  the  rise  in  pressure  after 
exercising  the  muscles,  and  the  deeper  the  remissions  of  the 
blood -pressure  curve  and  the  less  muscular  exercise  it  takes 
to  produce  such  remissions  of  pressure,  and  the  longer  it 

216 


He    a    rt-Suffic    i    e    n    c    y 

takes  for  the  blood -pressure  curve  to  attain  the  normal,  the 
greater  is  the  functional  incapacity  of  the  heart. 

3.  METHOD  OF  KATZENSTEIN. — After  determining  the 
blood -pressure  and  the  pulse  on  the  reclining  patient,  both 
of  the  femoral  arteries  are  compressed  with  the  middle 
finger   of   each   hand    at    Poupart's    ligament,    the    other 
fingers  testing  whether  the  compression  is  absolute.     With 
normal  heart -energy  the  blood -pressure  then  rises  by  from 
5  to  15  mm.  mercury,  while  the  pulse  remains  unaffected  or 
drops.     When  the  compression  is  relinquished,  the  blood- 
pressure  gradually  returns  to  normal.     A  slightly  enfeebled 
heart  is  not  able  to  raise  the  blood -pressure  when  the  ob- 
struction to  the  circulation  is  interposed,  and  with  a  much 
enfeebled  heart  the  blood -pressure  actually  sinks  under  the 
compression,  while  in  both  events  the  pulse  becomes  more 
or  less  accelerated.     The  respiration  is  kept  superficial  during 
compression. 

4.  HEART  REFLEX  METHOD. — After  taking  the  blood- 
pressure,  fix  over  the  heart-region  a  pleximeter  and  strike 
the  latter  a  series  of  vigorous  blows  with  a  hammer  (Fig.  2), 
after  which  immediately  take  the  pressure  again.     If  the 
myocardium  is  sufficient,  the  blood -pressure  remains  the 
same  or  rises ;  otherwise,  it  falls,  and  the  rise  and  fall  are  in 
proportion  respectively  to  the  vigor  and  insufficiency  of  the 
heart-muscle,  e.g.: 

BLOOD -PRESSURE   BEFORE   AND   AFTER   EXCITATION   OF   THE 

HEART-REGION. 
BEFORE.  AFTER.  CONCLUSION. 

120  mm 140  mm Myocardium  very  strong. 

135  mm 138  mm Myocardial  sufficiency. 

190  mm 155  mm Myocardial  insufficiency. 

Concussion  of  the  heart  region  elicits  a  maximum  heart 
reflex  with  a  temporary  augmentation  of  vigor  if  the  myocar- 

217 


S    p     ondylotherapy 

dium  is  normal,  otherwise,  the  stimulation  is  in  the  nature 
of  a  shock. 

TREATMENT  OF  CARDIAC  INSUFFICIENCY. 

One  must  concede  the  phenomenal  results  achieved  in 
cardiotherapeutics  since  the  inauguration  of  the  Schott 
methods  by  saline  baths  and  resisted  movements  in  failing 
heart -power.  If  the  Schott  methods  of  treatment  are 
effective,  their  efficiency  is  recognized  by  the  following 
results : 

1.  A  sensation  of  warmth. 

2.  Augmented  pulse- volume  with  diminished  frequency. 

3.  Stronger  cardiac  systole. 

4.  Diminished  area  of  cardiac  dullness. 

5.  Ameli oration  of  precordial  distress. 

6.  A  feeling  of  well-being. 

There  are  many  theories  concerning-  the  action  of  the 
saline  baths  and  resisted  movements,  but  in  the  opinion  of 
the  author,  the  theory  that  best  responds  to  reason  is  that 
which  supposes  their  action  to  be  due  to  the  elicitation  of 
the  heart  reflex.  From  what  has  been  said  concerning  the 
latter  reflex  (page  199),  it  is  known  that  cutaneous  stimulation 
of  any  kind  will  result  in  a  vigorous  contraction  of  the 
heart -muscle.  Hence,  mere  friction  of  the  skin  with  a  coarse 
towel  is  equally  as  efficient  as  the  waters  of  Bad  Nauheim, 
in  Germany,  which  owe  their  action  to  various  chlorid  salts 
and  to  the  presence  of  carbonic  acid.* 

In  studying  the  amplitude  of  the  heart  reflex  (Fig.  54), 
when  elicited  from  various  regions  of  the  organism,  the 

*"Dr.  Bloch,  of  Franzensbad,  uses  carbonic  acid  douches  for  producing  contraction 
of  the  heart,  based  on  the  fact  discovered  by  Dr.  Abrams,  of  San  Francisco, 
that  friction  of  the  precordial  region  will  produce  contraction  of  the  heart 
(Satterthwaite)." 

218 


Cardiac      I  n  s  u  f  f  i  c  i  e  n  c  y 

author  is  justified  in  concluding  that  the  most  effective  site 
is  the  spinous  process  of  the  *jth  cervical  vertebra,  and  that 
the  most  satisfactory  method  for  its  elicitation,  is  by  means 
of  the  pneumatic  hammer  (Fig.  50)  or  any  similar  apparatus 
giving  a  percussion  stroke.  In  the  absence  of  an  apparatus, 
mere  concussion  by  means  of  a  pleximeter  and  hammer 
(page  8)  may  be  employed. 

The  duration  of  each  seance  is  governed  by  the  results 
and  one  must  not  forget  that  a  reflex  may  be  exhausted  as 
well  as  excited.  My  usual  custom  is  to  limit  each  seance  to 
about  five  minutes  with  frequent  periods  of  rest  during  the 
application  of  the  percussion  stroke.  In  the  opinion  of  the 
author,  the  results  achieved  are  more  satisfactory  and  more 
rapid  than  by  any  other  method  of  treatment. 

Very  frequently  he  has  observed  cardiopaths  with  severe 
dyspnea  and  other  signs  of  heart  failure,  who  obtained 
immediate  relief  after  a  single  seance  of  concussion -treat- 
ment. 

It  is  evident,  however,  that  many  seances  are  necessary 
before  one  may  expect  permanent  results. 

It  is  equally  evident  that  concussion  must  not  be  em- 
ployed to  the  exclusion  of  other  methods  of  treatment 
in  failing  compensation,  although  the  author  has  employed 
concussion  exclusively  in  his  cases  to  enable  him  to  formulate 
conclusions  respecting  the  efficacy  of  the  method. 

Reference  to  Figs.  60  and  61  shows  the  effects  of  con- 
cussion of  the  yth  cervical  spinous  process  in  two  patients 
with  dilated  hearts  superinduced  by  myocarditis.  The  relief 
following  concussion  is  dependent  on  the  duration  of  the 
heart  reflex  which,  in  turn,  is  dependent  on  the  condition  of 
the  heart-muscle.  In  several  instances  of  myocarditis  no 
results  were  achieved  by  concussion,  but  in  these  cases  the 
myocardium  was  past  restitution. 

219 


S  p 


o     n 


d    y    I 


t    h 


r    a    p    y 


When  attacks  of  cardiac  asthma  (page  212)  or  other 
paroxysmal  symptoms  of  heart-failure  occur  at  the  home  of 
the  patient,  some  competent  member  of  the  family  is  instruct- 
ed to  concuss  the  spinous  process  of  the  yth  cervical  vertebra 
by  means  of  the  pleximeter  and  hammer. 


FIG.  60. — The  effects  of  concussion 
of  the  spine  of  the  yth  cervical  vertebra 
on  the  area  of  the  heart  in  a  patient 
with  myocarditis.  The  continuous  line 
represents  the  area  of  the  heart  before, 
and  the  broken  line  after,  concussion. 


FIG.  61. — The  effects  of  concussion 
of  the  spine  of  the  yth  cervical  vertebra 
on  the  area  of  the  heart  and  liver  in  a 
patient  with  advanced  myocarditis.  The 
continuous  line  represents  the  area  of 
the  heart  and  liver  before,  and  the 
broken  line  after,  concussion. 


As  a  rule,  the  latter  manceuver  is  followed  by  immediate 
relief  of  the  symptoms. 

As  observed  on  a  previous  page  (215),  some  patients 
owe  their  infirmity  to  heart-failure  and  many  anemic  women 
who  respond  unceasingly  to  the  demands  of  an  active  social 
life,  who  say  they  are  "worn  out,"  often  suffer  from  an  over- 
strained heart.  The  subjective  symptoms  are  lassitude, 
slight  dyspnea  on  exertion  and  digestive  disturbances. 

220 


Angina         Pectoris 

Objectively,  one  may  recognize  dilatation  of  the  ventricles 
by  percussion,  feeble  heart-tones,  and  a  pulse  which  is  rapid 
and  feeble  and  may  be  irregular  or  intermittent.  These 
cases,  as  well  as  those  hearts  which  fail  to  respond  to  the 
tests  of  cardiac  sufficiency  (page  215)  are  benefited  by 
concussion-treatment. 

ANGINA  PECTORIS. 
THE    HEART   REFLEX   OF   DILATATION. 

Heretofore  only  one  heart  reflex  was  recognized,  viz., 
the  heart  reflex  of  contraction  (page  199),  but  when  the 
spinal  processes  of  the  9th,  loth,  nth  and  i2th  dorsal 
vertebrae  are  rapidly  concussed  in  succession  there  is  a 
decided  increase  in  the  area  of  cardiac  dullness  as  obtained 
by  percussion.  This  increase  in  the  area  of  cardiac  dullness 
is  not  associated,  as  the  x-rays  show,  with  any  increase  in 
the  diameters  of  the  heart.  The  latter  fact  corresponds  with 
the  investigations  of  Kornfeld,  who  demonstrated  that  the 
heart -muscle  possesses  the  property  of  increasing  the  size  of 
its  cavities  without  any  corresponding  augmentation  of 
tension  of  its  walls,  a  condition  which  he  calls  Ausweitungs- 
f'dhigkeit. 

Among  the  theories  of  ANGINA  PECTORIS,  that  of  Allan 
Burns  appeals  most  cogently  to  reason. 

The  latter  assumes  that,  in  consequence  of  a  transient 
ischemia  of  the  heart -muscle  caused  by  disease  or  spasm  of 
the  coronary  arteries,  a  condition  analogous  to  intermittent 
claudication  ensues.  It  is  known  that  the  coronary  arteries 
are  practically  always  diseased  in  fatal  cases  of  angina,  but 
if  we  accept  the  observation  of  Schafer  that  the  coronary 
vessels  are  unprovided  with  vasomotor  nerves,  the  theory  of 
intermittent  claudication  of  the  coronaries  must  necessarily 
suffer  a  serious  setback  unless  supported  by  other  evidence. 

221 


S  p    o     n    d    y    I    o    t    h     e    r    a    p    y 

The  coronary  arteries  supply  the  heart  with  blood  only  during 
diastole,  for  during  systole  the  ventricular  wall  is  so  strongly 
contracted  that  the  muscular  tension  becomes  greater  than 
the  coronary  pressure  and  so  the  coronary  artery  and 
branches  are  compressed  and  the  blood  is  driven  back  into 
the  aorta.  It  is  our  contention  that  the  theory  of  Burns 
is  correct,  but  that  the  ischemia  is  quite  independent  of 
the  coronary  arteries,  which  are  merely  passive  structures. 
We  assume  that  any  factor  operating  to  augment  the 
tonicity  of  the  cardiac  musculature  compresses  the  arteries 
in  question  and  thus  induces  ischemia.  The  heart  reflex 
is  essentially  a  myocardial  contraction  and  when  the 
reflex  is  in  evidence  the  coronary  arteries  are  subjected 
to  varying  degrees  of  pressure.  If  in  an  attack  of  angina, 
the  pulse  shows  augmented  tension  and  is  small  and  perhaps 
diminished  in  rate,  or  if  syncope  is  observed,  such  symptoms 
are  explainable  by  the  heart  reflex. 

We  know  that  when  the  reflex  is  in  evidence,  the  heart  is 
practically  inhibited;  there  is  a  diminished  output  of  blood 
into  the  general  circulation  and,  if  the  pulse  shows  increased 
tension,  it  is  only  an  expression  of  vaso-motor  activity  which 
assumes  the  burden  of  maintaining  the  circulation. 

If  one  studies  the  etiology  of  angina,  one  notes  that  the 
factors  which  precipitate  a  paroxysm  are  also  equally 
operative  in  inducing  the  heart  reflex.  Muscular  effort  is  a 
potent  factor  which  also  provokes  the  myopathic  heart  reflex. 
Emotion  is  another  prominent  factor  and  led  John  Hunter  to 
observe  that  "his  life  was  in  the  hands  of  any  rascal  who 
chose  to  annoy  and  tease  him."  Emotion  as  a  cause  corre- 
sponds with  the  psychic  heart  reflex.  A  gust  of  wind  striking 
the  chest  is  equally  involved  in  inducing  either  an  attack  of 
angina  or  the  heart  reflex. 

Oliver  demonstrated  that  patients  who  have  suffered  from 

222 


Angina         Pectoris 

precordial  pain  obtain  permanent  relief  on  the  supervention 
of  cardiac  dilatation  and  failure,  and  Broadbent  has  shown 
that  the  supervention  of  mitral  insufficiency  may  diminish 
the  tendency  to  anginoid  attacks. 

Now,  in  cardiectasis,  while  the  heart  reflex  can  be 
provoked,  the  cardiac  musculature  is  enfeebled  and  the 
resulting  pressure  on  the  coronary  arteries  is  correspondingly 
diminished.  Reference  has  been  made  to  the  heart  reflex  of 
dilatation  and  in  several  instances,  during  my  office  hours, 
I  have  inhibited  anginoid  pains  by  concussion  of  the  vertebrae 
which  induces  cardiac  dilatation,  and  I  have  employed  the 
same  method  with  fairly  good  results  in  the  treatment  of 
angina  pectoris.  In  other  instances,  I  have  unintentionally 
provoked  attacks  of  angina  in  studying  the  heart  reflex  and 
the  methods  for  its  elicitation. 

Here  concussion  of  the  spinous  process  of  the  yth  cervical 
vertebra  is  often  effective  in  developing  some  of  the  symptoms 
of  angina  pectoris  when  absent  and  the  same  may  be  said 
of  concussion  of  the  precordial  region.  Thus,  concussion 
from  either  region  is  a  diagnostic  sign  of  some  importance 
and  serves  as  corroborative  evidence  of  the  author's  heart 
reflex  theory  of  angina  pectoris.  Not  infrequently  eructa- 
tions of  gas  attend  the  concussion  and  here  it  is  assumed, 
that  concussion  not  only  provokes  the  heart  reflex  by  reflex 
stimulation  of  the  vagus,  but  also  the  stomach  reflex  of 
contraction  (page  316). 

By  means  of  the  heart  reflex,  one  can  easily  comprehend 
the  attacks  of  false  angina.  In  functional  angina,  the  heart 
reflex  is  always  accentuated,  as  I  have  assured  myself  by 
repeated  x-ray  examinations.  In  cardiodynia  (Herzangst) 
observed  in  neurotics,  one  is  dealing  essentially  with  a 
psychic  heart  reflex. 

The  following  table  will  aid  in  the  differentiation  of  true 
and  false  angina  pectoris : 


S   p 


o    n 


t    h 


r    a   p   y 


DIFFERENTIAL  TABLE  OF  TRUE 

TRUE  ANGINA. 

Most  frequent  between  the  ages  of 
40  and  50  years. 

More  frequent  in  males  and  the 
paroxysms  are  evoked  by  exer- 
tion. The  attacks  are  rarely 
periodic  and  nocturnal. 

No  other  symptoms. 

Pain  is  agonizing  with  the  sensa- 
tion of  compression  by  a  vice. 

The  pain  is  of  short  duration  and 
the  patient  is  silent  and  immo- 
bile. 

The  lesion  is  a  sclerosis  of  the 
coronary  artery. 

Prognosis  grave.' 

Arterial  medication  is  effective. 
Antipyrin  (large  dose)  may  ac- 
centuate the  pain,  at  any  rate  it 
gives  no  relief. 


AND  FALSE  ANGINA  PECTORIS. 
FALSE  ANGINA.* 

(Neurotic  Form.) 
May  occur  at  any  age  and  even 

in  children. 

More  frequent  in  women  and  the 
attacks  are  spontaneous,  peri- 
odic and  nocturnal. 

Associated  with  nervous  symp- 
toms. 

Pain  is  less  severe  and  the  sensa- 
tion is  one  of  distention. 

Pain  may  continue  for  one  or  two 
hours  and  the  patient  is  restless 
and  talkative. 

Neuralgia  of  nerves  and  cardio- 
plexus. 

Never  fatal. 

Antineuralgic  medication.  Anti- 
pyrin (large  dose)  is  effective  in 
subduing  the  pain  (Huchard). 


There  are  etiological  factors  concerned  in  angina  which 
on  first  view  could  find  no  explanation  by  my  heart  reflex 
ischemic  theory,  yet,  on  reflection,  the  theory  is  applicable. 
Thus,  one  of  my  friends,  a  physician  in  Paris,  suffers  like 
several  other  members  of  his  family  from  pronounced  attacks 
of  angina  pectoris  several  hours  after  the  use  of  coffee,  tea 
or  tobacco.  One  knows,  for  instance,  that  the  effect  of 
caffeine  in  small  doses  on  the  cardiac  muscle  is  to  increase 
its  activity ;  in  larger  doses,  it  produces  phenomena  analogous 
to  fatigue,  and  in  very  large  doses,  the  muscle  is  thrown  into 

*Reference  on  page  194  has  already  been  made  to  false  angina  caused  by  intercostal 
neuralgia. 

224 


g 


n     a 


c    t    o     r 


rigor.  In  the  latter  instance,  the  strong  contraction  of  the 
myocardium  (which  is  essentially  a  heart  reflex)  mechanically 
compresses  the  coronary  vessels. 

The  toxic  factor  here  involved  in  eliciting  the  heart  reflex 
is  necessarily  delayed  and  cannot  be  immediate  like  the  other 
factors  concerned  in  the  elicitation  of  the  reflex  in  question. 
Digitalis  and  other  circulatory  stimulants  may  provoke  an 
attack  of  angina  for  the  reason  that  they  augment  the  tonicity 


FIG.  62. — The  heart  reflex;  A  before,  and  B,  after,  the  use  of  digitalis. 

of  the  cardiac  musculature.  Digitalis  increases  the  ampli- 
tude of  the  heart  reflex  as  shown  in  Fig.  62. 

Recently  I  have  observed  the  following  singular  phenom- 
enon :  After  placing  the  ankle  of  one  lower  extremity  on  the 
knee  of  the  other  extremity,  the  pulse  of  the  anterior  tibial 
artery  is  easily  palpated  (Fig.  63). 

Next,  direct  the  patient  forcibly  to  extend  and  flex  his 
foot  (the  leg  occupying  the  same  position)  a  number  of 

225 


Spondylotherapy 

times  in  succession.  If  the  tibial  pulse  is  again  sought,  it 
will  be  either  very  feeble  or  absent.  In  the  norm  fully  thirty 
seconds  may  elapse  before  the  pulse  has  attained  its  former 
volume.  The  blood -pressure  also  falls.  In  a  patient  with 
claudication,  five  minutes  elapsed  before  the  tibial  pulse 
resumed  its  former  volume.  This  test  may  prove  of  value 
in  the  diagnosis  of  the  latter  affection.  I  assume  that  the 
tibial  artery,  immersed  as  it  is  in  a  muscular  atmosphere, 
responds  reflexly  to  the  muscular  contractions,  and  in  arte- 


FlG.  63. — Position  of  the  leg  to  facilitate  palpation  of  the  anterior  tibial  artery. 

riosclerosis  the  longer  duration  of  the  arterial  contraction 
accounts  for  the  phenomena  of  claudication.  Here,  as  in 
my  heart  reflex  theory  of  angina,  the  ischemia  is  dissociated 
with  vaso-motor  action,  insomuch  as  when  amyl  nitrite  is 
inhaled,  obliteration  of  the  tibial  artery  is  effected  by  the 
muscular  manceuver  suggested. 

The  treatment  of  angina  pectoris  includes  the  elimination 
of  all  factors  concerned  in  the  elicitation  of  the  heart  reflex. 
The  value  of  amyl  nitrite  inhalation  in  the  treatment  of  a. 

226 


Angina         Pectoris 

paroxysm  is  universally  conceded.  When  the  latter  drug 
fails,  and  it  often  does,  the  failure  may  be  attributed  to 
irritation  of  the  nasal  mucosa  which  induces  the  heart  reflex, 
which  would  still  further  accentuate  the  paroxysm.  In  such 
instances  and,  in  fact,  in  nearly  all  instances,  the  action  of 
the  drug  in  question  is  aided  by  previous  cocainization  of 
the  nasal  mucosa,  which  eliminates  the  irritant  factor  in 
amyl  nitrite  inhalations.  Concussion  of  the  lower  dorsal 


FIG.  64. — Demonstrating  the  amplitude  of  the  heart  reflex:  C,  left  border  of 
the  deep  cardiac  dullness;  A,  recession  of  the  same  border  when  the  heart  reflex 
is  elicited  after  excitation  of  the  precordial  region;  B,  still  further  recession  of  the 
same  border  when  the  heart  reflex  is  elicited  after  concussion  of  the  spinous  proc- 
ess of  the  7th  cervical  vertebra.  Note  in  this  figure  that  after  concussion  of  the 
four  lower  dorsal  vertebrae  to  excite  the  heart  reflex  of  dilatation,  the  amplitude 
of  the  heart  reflex  of  contraction  after  concussing  the  spinous  process  of  the  7th 
cervical  vertebra  is  from  C  to  A  only. 

vertebrae  (daily  treatment)  should  be  given  a  trial  in  the 
treatment  of  angina  pectoris  to  induce  the  counter-reflex  of 
dilatation. 

It  will  be  noted  in  Fig.  64,  that  after  the  heart  reflex  of 
dilatation  is  elicited,  the  amplitude  of  the  heart  reflex  of 
contraction  is  diminished.  In  some  instances,  the  treat- 
ment suggested  for  angina  pectoris  (true  and  false)  and 

227 


Spondyloth 


r    a   p    y 


cardiodynia  is  very  effective,  whereas  in  other  instances,  no 
results  are  achieved. 

FUNCTIONAL  AFFECTIONS   OF  THE  HEART. 
INHIBITION  OF  THE  HEART. 

The  rapidity  and  force  of  cardiac  action  are  regulated  by 
the  pneumogastric  or  vagus  nerve,  which  inhibits  it,  and  the 


FIG.  65. — Position  of  head  to  inhibit  the  heart.     This  position  is  the  one 
adopted  for  obtaining  the  vago-visceral  reflexes  (q.  v.). 

sympathetic,  which  accelerates  it.  Many  persons  can  volun- 
tarily stop  the  action  of  the  heart,  and  among  Indian 
sorcerers,  the  phenomenon  is  regarded  as  a  marvelous  feat. 
The  explanation,  however,  is  very  simple:  by  voluntary 
contraction  of  the  muscles  of  the  neck  innervated  by  the 

228 


Heart     -     Inhibition 

nervus  accessorius,  the  branches  of  the  latter  running  in  the 
path  of  the  vagus  nerve  are  irritated,  resulting  in  temporary 
stoppage  of  the  heart  action.  Czermak  was  able  to  press 
his  vagus  nerve  against  a  little  bony  tumor  in  the  neck,  and 
by  thus  subjecting  the  nerve  to  mechanic  stimulation  was 
able  to  slow  or  even  stop  the  beating  of  his  own  heart. 

If,  in  almost  any  healthy  person,  the  carotid  artery,  or  a 
point  immediately  adjacent  to  it  in  the  neck,  is  compressed, 
slowing  or  complete  inhibition  of  the  heart  and  pulse  ensues. 
This  phenomenon  is  explained  by  compression  of  the  vagus 
lying  alongside  the  carotid  artery. 

The  author  has  shown,  that  forcible  compression  of  the 
abdominal  muscles  (Fig.  59),  inhalation  of  irritating  vapors, 
firm  pressure  in  any  of  the  intercostal  spaces  and  pressure 
at  the  vertebral  exits  of  the  spinal  nerves  (preferably  at 
the  side  of  the  upper  dorsal  vertebrae,  Fig.  48),  will 
result  in  a  reflex  inhibition  of  the  heart.  A  method  which 
the  author  employs  for  this  purpose  is  to  have  the  patient 
firmly  contract  the  muscles  of  the  neck  as  shown  in  Fig.  65. 

There  are  many  functional  NEUROSES  OF  THE  HEART, 
such  as  palpitation,  arrhythmia  and  tachycardia,  which  owe 
their  origin  to  insufficiency  of  the  vagus  nerve,  and  in  con- 
sequence of  such  incompetency,  the  mastery  of  the  organ  is 
assumed  by  the  sympathetic. 

Now  we  know  that  the  action  of  the  vagus  can  be  reflexly 
controlled  by  the  manceuvers  already  cited,  and  in  this 
action,  acceleration  and  irregularity  of  the  heart  can  be 
mastered.  By  executing  such  a  manceuver,  we  are  merely 
subduing  one  reflex  by  its  counter-reflex. 

In  a  case  of  tachycardia  (heart -hurry)  reported  by 
Nothnagel,  the  attacks  were  jugulated  by  deep  inspirations, 
and  Rosenfeld's  patient  controlled  her  attack  by  going  to 
bed,  raising  her  head  with  her  feet  planted  firmly  against 

229 


Spondyloth     e    r    a   p    y 

the  foot  of  the  couch,  and  then  taking  a  forced  inspiration 
she  pressed  down  with  all  her  might,  with  the  object  of 
closing  her  glottis. 

A  patient  of  mine,  a  neurasthenic,  controlled  his  attacks 
of  palpitation  by  firm  compression  of  an  intercostal  space 
with  his  finger. 

An  analysis  of  the  foregoing  manceuvers,  acquired 
instinctively,  shows  that  what  the  patients  did  was  to  call 
into  action  the  functions  of  the  vagus  nerve. 

The  spinal  region  in  juxtaposition  to  the  vertebral  exits 
of  the  upper  spinal  nerves  (at  about  the  spinous  process  of 
the  4th  dorsal  vertebra),  is  the  most  favorable  site  for  calling 
into  activity  the  functions  of  the  inhibitory  nerve  of  the  heart. 
Here  the  most  suitable  method  is  to  make  firm  compression 
(and  maintain  the  compression  for  several  minutes)  with  the 
thumbs  on  either  side  of  the  spine. 

The  application  of  an  ice-bag  in  the  region  shown  in 
Fig.  48  (corresponding  to  yth  cervical  spine)  is  often  of 
service  and  the  same  may  be  said  of  the  sinusoidal  current; 
one  electrode  in  the  sacral  region  and  the  other  electrode 
in  the  region  indicated  in  Fig.  48.  In  arrhythmia,  the 
action  of  this  current  is  often  surprisingly  efficient. 

The  latter  manceuver  is  equally  available  in  diagnosis. 
Thus,  in  irregular  action  of  the  heart  or  in  delirium  cordis, 
the  inhibition  manoeuver,  by  temporarily  inhibiting  the 
rapidity  of  the  heart,  enables  us  to  determine  the  time  of  a 
murmur;  the  manoeuver  thus  simulating  the  physiologic 
action  of  digitalis.* 


*Concerning  the  further  employment  of  this  manoeuver  in  diagnosis,  vide  "Diseases 
of  the  Heart,"  by  the  author,  page  59. 

230 


The      Blood-Vessels 

THE  BLOOD-VESSELS. 
PHYSIOLOGY. 

The  blood -pressure  is  most  evident  in  the  arteries  and 
least  pronounced  in  the  veins,  whereas  in  the  capillaries,  it 
is  intermediate  between  the  arteries  and  veins.  Thus  the 
blood  circulates  continuously  in  the  direction  of  the  lowest 
pressure  (arteries  to  veins). 

Arterial  pressure  or  tension  is  made  up  of  four  factors : 

1.  Ventricular  pressure. 

2.  Peripheral  resistance. 

3.  Elasticity  of  the  arterial  walls. 

4.  The  volume  of  the  circulating  blood. 

INNERVATION  of  the  blood-vessels  is  effected  through  the 
vaso -motor  nervous  system,  which  consists  of  the  center  in 
the  bulb,  subsidiary  centers  in  the  spinal  cord  and  vaso-motor 
nerves. 

The  latter  are  of  two  kinds :  Vasoconstrictor  nerves,  which 
when  stimulated  cause  contraction  of  the  vessels,  and  vaso- 
dilator nerves,  which  dilate  the  vessels.  The  latter  supply 
the  musculature  of  the  vessels  and  regulate  their  caliber,  and 
their  most  pronounced  action  is  on  the  arterioles,  which 
contain  relatively  the  largest  amount  of  muscular  tissue.  In 
the  norm,  the  arterioles  are  in  a  state  of  tonic  contraction, 
and  this  is  what  constitutes  the  peripheral  resistance  which 
helps  to  maintain  the  blood -pressure  and  thus  promotes  the 
circulation  of  the  blood.  By  means  of  the  vaso-motor 
apparatus  the  amount  of  blood  supplied  to  an  organ  is  regu- 
lated. Thus,  during  digestion  more  blood  must  be  supplied 
to  the  digestive  organs,  hence  the  arterioles  of  the  splanchnic 
area  are  relaxed  and  there  is  a  constriction  of  the  vessels  in 
other  areas,  as,  for  example,  the  skin;  the  chilly  sensations 
after  a  meal  are  attributable  to  the  latter  fact.  In  certain 

231 


Spondyloth     e     r    a    p    y 

organs,  like  the  lung  and  brain,  there  are  no  vaso-motor 
nerves,  because  there  are  no  variations  in  the  blood -supply. 
There  are  afferent  impulses  which  may  reflexly  excite  the 
vaso-motor  center  in  the  medulla,  and  such  impulses  are 
divided  into  pressor  and  depressor.  Most  sensory  nerves 
contain  pressor  fibers  which,  when  stimulated,  cause  a  rise 
of  blood -pressure,  whereas  the  depressor  fibers  also  present 
in  many  sensory  nerves  will,  when  stimulated,  cause  a  fall 
of  blood -pressure.  A  distinct  nerve  known  as  the  depressor 
nerve  exists  in  animals  in  the  trunk  of  the  vagus,  or  as  a 
separate  branch  running  from  the  heart  or  the  commence- 
ment of  the  aorta,  and  reaches  the  vaso-motor  center  by 
joining  the  vagus. 

PATHOLOGIC  PHYSIOLOGY. 

The  primary  factor  in  blood -pressure  is  the  force  of 
ventricular  systole,  and  any  increase  in  the  volume-output 
causes  a  rise,  and  conversely  a  fall,  in  pressure,  provided 
the  peripheral  resistance  is  the  same.  In  animals  the  pulse- 
rate  is  slowed  when  the  arterial  pressure  is  raised  and 
accelerated  when  lowered.  A  continued  high  blood -pressure 
entails  increased  work  on  the  part  of  the  heart,  but  the 
abnormal  tension  of  the  ventricular  wall  stimulates  the  fila- 
ments of  the  depressor  nerve  and  thus  automatically  causes 
a  fall  of  pressure.  Another  protective  mechanism  exists  to 
prevent  excessive  blood -pressure,  and  that  is,  when  the 
peripheral  resistance  is  very  much  augmented,  the  volume - 
output  of  the  ventricle  diminishes.  Peripheral  resistance,  as 
has  been  noted,  is  made  up  of  the  tonus  of  the  arterioles, 
but  there  are  minor  factors  also  concerned,  notably,  friction 
due  to  the  viscosity  of  the  blood  and  the  subdivisions  of  the 
arterial  tree.  It  has  been  showrn  that  the  veins  also  possess 
tonus.  Thus,  stimulation  of  a  splanchnic  nerve  will  produce 
a  contraction  of  the  portal  vein.  The  vasodilator  have  not 

232 


Blood 


r    e    s    s    u 


the  same  physiologic  value  as  the  constrictor  nerves,  for 
their  division  causes  no  narrowing  of  the  vessel,  hence  they 
possess  no  tonus.  It  has  been  shown  that  stimulation  of 
the  muscles  and  the  mucosa  of  the  rectum  and  vagina  will 
cause  a  fall  of  blood -pressure,  and  this  fact  is  more  evident 
during  anesthesia.  In  the  latter  instance  depressor  in  lieu 
of  pressor  reflexes  occur.  The  abdominal  vessels  supplied 
by  the  splanchnic  nerves  have  the  most  pronounced  influence 
on  the  general  blood -pressure,  for  the  evident  reason  that 
they  are  sufficiently  capacious  to  hold  practically  all  the 
blood -volume  of  the  body.  Arterial  elasticity  diminishes  the 
work  of  the  heart.  Hasebroek  contends  that  there  is  a  pro- 
pulsive energy  at  the  periphery  independent  of  that  in  the 
heart,  and  that  the  periphery  represents  another  second 
independent  pumping  apparatus,  coupled  with  that  of  the 
heart.  The  periphery  has  not  only  its  elastic  contraction  and 
expansion,  but  also  its  active  diastole  and  systole  in  the 
arteries.  This  diastolic -systolic  activity  is  manifested  in  the 
capillaries  as  a  sucking-in,  an  inspiration,  as  it  were,  while 
in  the  arteries  it  is  more  of  a  propulsive  energy.  Both 
these  forces  combine  to  create  an  independent  and  forcible 
stream  into  the  veins,  which  are  passive,  and  merely  serve 
as  a  passive  reservoir  for  the  blood -stream. 

The  blood-volume  has  only  a  subordinate  influence  on 
blood -pressure,  as  many  experiments  show.  When  the 
blood-volume  is  diminished,  pressure  is  maintained  by 
peripheral  contraction  of  the  arterioles,  and  when  the  volume 
is  increased,  certain  compensatory  mechanisms  come  into 
play,  viz.,  dilatation  of  the  vessels,  transudation  into  serous 
cavities  and  lymph-spaces,  and  increased  activity  of  the 
secreting  organs.  Another  important  factor  in  compensation 
is  dilatation  of  the  arterioles  of  the  abdominal  viscera  caused 
by  stimulation  of  the  depressor  nerve. 

233 


Spondyloth     e     r    a   p    y 

NORMAL  BLOOD-PRESSURE. — Pressure,  like  temperature 
and  the  rate  of  respiration,  is  subject  to  fluctuations.  Most 
of  the  recorded  results  have  been  obtained  with  the  Riva- 
Rocci  apparatus  and  the  figures  quoted  represent  the  systolic 
pressure.  Cook  and  Briggs  present  the  following  as  repre- 
senting the  average  pressure: 

Children  up  to  two  years 75  to    90  mm. 

Children  after  two  years 90  to  1 10  mm. 

Young  adult  males,  about 130  mm. 

Women icto    15  mm.  lower. 

A  pressure  below  70  mm.  signifies  very  low,  and  above 
200  mm.  very  high  tension. 

Janeway  has  never  seen  a  pressure  above  180  mm.  in  a 
normal  person,  and  seldom  one  above  160  mm.  There  are 
postural  variations  of  pressure,  hence  all  pressure  estimations 
should  be  taken  in  the  same  position.  Sleep  lowers  the 
pressure.  Tobacco  either  increases  or  diminishes  the  pres- 
sure according  to  whether  the  subject  experiences  a  stimu- 
lating or  sedative  effect ;  this,  at  least,  has  been  my  observa- 
tion. Emotional  influences  and  intellectual  application  in- 
crease the  pressure.  Muscular  exertion  increases  the  pressure, 
owing  to  augmented  ventricular  force;  if,  however,  exertion 
is  carried  to  exhaustion,  the  pressure  falls. 

BLOOD -PRESSURE  IN  DISEASE. 

Among  the  dominant  factors  inducing  high  pressure 
(hypertension}  are  pains  of  all  kinds  which  reflexly  cause  a 
stimulation  of  vaso -motor  tone.  Drugs  like  strychnin,  digitalis, 
adrenalin,  and  other  cardiotonics  act  by  increasing  either 
the  peripheral  resistance  (vasoconstriction)  or  cardiac  energy 
or  both.  Vasoconstriction  is  evoked  by  many  toxic  conditions 
(plumbism,  nicotinism,  gout,  uremia).  No  doubt  a  toxic 

234 


Blood  Pressure 

factor  is  also  present  in  many  psychoses.  During  labor 
pains  two  factors  are  present,  the  pain  and  the  increased 
volume  of  blood  sent  to  the  heart  by  compression  of  the 
abdominal  vessels.  In  renal  affections  the  cause  of  high 
pressure  is  due  to  a  number  of  conditions,  notably,  cardiac 
hypertrophy  and  increased  peripheral  resistance  due  to  a 
vaso-motor  spasm  provoked  by  the  irritating  action  of  waste- 
products  in  the  blood  or  degeneration  of  the  peripheral 
vessels  or  both.  Hypertension  necessarily  increases  the  work 
of  the  heart 'unless  a  compensatory  factor  is  brought  into 
play,  and  the  primary  effect  is  to  cause  cardiac  hypertrophy. 
A  hypertrophic  heart  is  by  no  means  as  good  as  a  normal 
one,  as  the  old  dictum  runs,  for,  sooner  or  later,  that  heart 
will  become  insufficient.  Hypertension  diminishes  the  elastic 
distensibility  of  the  arterial  wall,  and  this  in  turn  conduces 
to  dilatation  (aneurism)  and  rupture  (cerebral  hemorrhage) 
of  the  vessels.  Diminished  pressure  (hypotension)  is 
usually  regarded  as  such  when  the  systolic  pressure  in  an 
adult  is  below  100  mm.  Any  or  all  of  the  factors  concerned 
in  blood -pressure  may  be  involved ;  wasting  diseases  reduce 
pressure  by  compromising  all  these  factors.  The  vasodi- 
lators reduce  pressure  by  diminishing  the  peripheral  resist- 
ance and  chloroform  acts  by  directly  paralyzing  the  vaso- 
motor  center  or  heart.  In  acute  infectious  diseases  the  fall 
in  pressure  is  due  in  part  to  vaso-motor  paralysis  and  in  part 
to  weakness  of  the  heart -muscle.  Hypotension  causes  blood 
to  accumulate  in  the  veins  (notably  the  abdominal)  and 
diminishes  the  rapidity  of  the  circulation.  The  vigor  of  the 
heart  becomes  compromised  because  it  receives  less  blood. 

In  affections  of  the  nervous  system  Pal  found  that  in 
tabes,  during  the  occurrence  of  lightning  pains,  the  pressure 
fell,  and  that  during  gastric  and  abdominal  crises  there  was 
an  enormous  augmentation  of  pressure,  hence  he  concludes 

235 


S    p     o    n    d    y    I    o     t    h     e     r    a   p    y 

that  the  latter  are  caused  by  a  spasm  of  the  splanchnic 
vessels.  Cerebral  hemorrhage,  like  all  other  conditions  in- 
creasing intracranial  tension,  will  cause  an  increase  of 
pressure  in  proportion  to  the  degree  of  such  tension.  A  high 
and  rising  pressure  points  to  more  bleeding  and  a  progressive 
failure  of  the  circulation  in  the  medulla.  The  observations 
of  Bruce  show  that  in  insomnia  there  are  cases  with  high 
and  low  pressure,  and  that  the  administration  of  erythrol 
tetranitrate  to  the  former  acted  as  a  hypnotic  (if  it  reduced 
tension). 

In  arteriosclerosis  (which  will  be  discussed  later  at  great 
length),  the  pressure  is  usually  high. 

The  arteries  may  be  thickened  and  yet  no  rise  of  pressure 
exists ;  in  fact,  if  the  heart-muscle  is  weak,  the  pressure  may 
even  be  lower  than  normal.  Janeway  concludes  that  high 
pressure  in  this  disease  indicates  involvement  of  the  small 
arteries,  especially  in  the  splanchnic  circulation.  Among 
the  symptoms  of  arteriosclerosis  are  headache,  vertigo, 
apoplectiform  attacks,  and  irritability.  Such  symptoms  are 
accentuated  when  the  pressure  is  high,  and  are  aggravated 
by  raising  the  latter  with  subcutaneous  injections  of  adrenalin 
and  ameliorated  by  the  use  of  vasodilators.  Amyl  nitrite 
inhalation  may  be  tried  to  rapidly  secure  the  latter 
action. 

Sphygmomanometry  has  been  utilized  in  tracing  the 
etiology  of  insomnia.  Thus,  it  is  claimed  that  when  the 
latter  is  caused  by  auto-intoxication,  the  blood -pressure  is 
augmented,  whereas  it  is  very  low  in  the  insomnia  of  neu- 
rasthenia. 

Marfan  contends  that  arterial  hypotension  is  the  rule  in 
chronic  pulmonary  tuberculosis,  and  that  a  normal  or  increased 
pressure  indicates  a  favorable  prognosis.  When  the  tension 
at  the  commencement  of  the  treatment  is  low,  and  is  subse- 

236 


Blood  Pressure 

quently  raised,  the  prognosis  is  equally  favorable.  Inversely, 
a  constant  low  pressure  portends  an  unfavorable  course. 

In  the  differential  diagnosis  between  gouty  and  tuber- 
culous affections  of  the  skin  or  elsewhere,  a  high  pressure 
argues  in  favor  of  the  former  and  a  low  pressure  in  favor  of 
the  latter  affection.  Albuminuria  is  probably  of  renal 
origin  if  the  pressure  is  high.  In  neurasthenia  due  to 
intestinal  auto-intoxication  the  pressure  is  usually  high,  and 
treatment  addressed  to  the  condition  will  lower  the  pressure, 
whereas  in  neurasthenia  due  to  actual  exhaustion,  the  pres- 
sure is  low. 

In  high  blood -pressure  due  to  augmented  tonus  of  the 
vaso-motor  center  (usually  present  in  neurasthenic  conditions) 
the  bromids  carried  to  their  physiologic  effects  will  cause 
such  pressure  to  fall.  When  dependent  on  the  absorption  of 
enterotoxins,  the  abdominal  application  of  the  sinusoidal 
current  for  a  week  (daily  seances  of  fifteen  minutes)  will 
cause  a  marked  reduction  in  blood -pressure,  otherwise  the 
influence  of  the  current  is  without  pronounced  effect.  Amyl 
nitrite  inhalations  and  nitrogylcerin  are  transitory  in  their 
action  in  reducing  pressure.  Cook  found  that  sodium 
nitrite  is  less  transitory  in  its  action,  and  that  one  or  two 
grains  averages  a  fall  of  from  25  to  50  mm.  Hg,  coming  on 
rapidly  in  from  five  to  ten  minutes  on  an  empty  stomach, 
and  its  effects  may  last  as  long  as  four  hours.  Veratrum 
viride  is  more  permanent  in  its  effects  for  vasodilation  than 
the  other  remedies  mentioned. 

The  testimony  of  clinicians  concerning  pressure -figures  in 
diseases  of  the  heart  are  very  conflicting,  and  I  must  there- 
fore still  adhere  to  my  observations  concerning  this  subject, 
and  referred  to  elsewhere  (page  239). 

Janeway  regards  pressure  as  a  means  of  differentiation 
between  true  and  false  angina,  and  observes  that  in  the  pres- 

237 


S  p    o    n    d    y    I    o     the    r    a    p    y 

ence  of  a  pressure  above  180  mm.  anginoid  pain  is  dependent 
on  organic  disease.  In  chronic  interstitial  nephritis  high 
pressure  is  an  early  and  important  symptom.  In  other  renal 
affections  the  question  of  pressure  is  less  important.  Uremic 
symptoms  cause  a  rise  in  pressure,  and  that  improvement 
spontaneous  or  as  a  result  of  treatment  will  cause  the  pressure 
to  fall.  In  fact,  many  writers  claim  that  uremic  symptoms 
(headache,  vertigo,  etc.)  are  the  result  of  high  pressure. 

In  typhoid,  fever  observations  to  be  of  any  value  must  be 
made  daily  with  the  sphygmomanometer,  just  as  one  makes 
the  record  of  the  pulse  and  temperature.  In  this  disease 
the  pressure  begins  to  fall  with  the  development  of  toxemic 
symptoms,  and  one  notes  that  this  fall  is  progressive.  The 
following  figures  of  Crile  are  interesting:  The  highest 
pressure  in  115  cases  was  138  mm. ;  the  lowest,  74  mm. ;  and 
the  average,  104  mm.  The  average  pressure  in  the  first 
week  of  the  disease  was  115  mm. ;  second,  io6mm. ;  third,  102 
mm. ;  fourth,  96  mm. ;  and  in  the  fifth  week,  98  mm.  A  rapid 
fall  in  pressure  indicates  hemorrhage,  whereas  a  progressive 
fall  suggests  enfeeblement  of  the  vaso-motor  centers.  If  per- 
foration occurs,  there  is  usually  a  sudden  rise  of  pressure. 
The  fall  of  pressure  in  this  disease  suggests  the  value  of 
cardiotonic  medication,  which  in  most  instances  is  of  more 
value  than  the  measures  employed  for  reducing  the 
temperature. 

In  surgery  blood -pressure  estimations  are  of  unquestion- 
able value.  The  use  of  ether  as  an  anesthetic  either  causes 
the  pressure  to  rise,  to  be  unaffected,  or  in  a  very  small 
proportion  of  the  cases  to  fall.  Chloroform,  as  a  rule,  dimin- 
ishes the  pressure.  Peripheral  operations  involving 
irritation  of  nerve-endings  and  nerve-trunks  cause  a  rise  in 
pressure,  and  it  has  been  suggested  that  sudden  death 
following  trivial  operations  may  be  caused  by  rupture  of 

238 


Blood-      P 


u 


diseased  cerebral  arteries,  the  result  of  a  sudden  increase  of 
pressure.  Hemorrhage  in  an  anesthetized  patient  causes  a 
sudden  fall  of  pressure  followed  by  a  rise,  provided  the 
bleeding  is  not  severe  or  complicated  by  shock.  In  collapse 
and  shock  a  fall  of  blood -pressure  is  one  of  the  most  positive 
signs,  and  the  fall  is  always  in  proportion  to  their  severity. 
According  to  Crile,  collapse  is  a  sudden  shock,  a  progressive 
fall  of  pressure,  and  in  which  the  vaso-motor  center  does  not 
respond  to  stimuli.  In  these  cases  the  danger  exists  in  loss 
of  the  vaso-motor  and  not  of  the  cardiac  function.  The  use 
of  chloroform  is  interdicted  when  shock  is  feared  and  pe- 
ripheral stimuli  are  inhibited  by  "blocking"  large  nerves  by 
means  of  cocain  before  their  division.  Bishop  has  directed 
attention  to  a  constitutional  condition  of  low  arterial  tension 
in  children  in  whom  no  heart  lesion  exists.  Such  children 
suffer  discomfort  for  lack  of  circulation  (cold  feet,  depression 
and  fainting  attacks).  The  functional  heart-tests  show  that 
the  heart  is  not  compromised.  Otis,  of  Boston,  suggests 
that  blood -pressure  should  be  taken  as  a  routine  measure. 
The  average  blood -pressure  in  tuberculous  persons  is  about 
126,  and  a  fall  in  tension  is  suggestive  of  impending  hem- 
orrhage. This  latter  may  be  warded  off  by  ergot.  In 
hemorrhage  when  the  blood -pressure  for  the  individual  is 
high,  inhalations  of  amyl  nitrite  or  nitroglycerin  may  be 
used  internally ;  if  low,  ergotin  is  injected  subcutaneously. 

THE  VASO-MOTOR  FACTOR  IN  BLOOD -PRESSURE. 

Among  the  factors  which  contribute  to  blood -pressure, 
the  resistance  offered  by  the  blood-vessels  is  paramount. 

If  the  vessels  are  dilated,  the  pressure  falls ;  if  contracted, 
it  will  rise.  The  nervous  mechanism  which  presides  over 
the  tonus  of  the  blood-vessels  is  the  vaso-motor  apparatus, 
and  while  the  latter,  I  concede,  may  be  reflexly  influenced 

239 


Spondylotherapy 

by  irritation  from  the  blood-vessels  themselves  or  from  the 
end -organs  of  sensory  nerves  in  general,  we  are  inclined  to 
forget  that  the  vaso-motor  apparatus  may  operate  independ- 
ently of  such  influences.  Emotions,  and  the  state  of  mind 
in  general,  greatly  influence  the  caliber  of  the  blood-vessels 
through  the  vaso-motor  system  of  nerves.  Take  neuras- 
thenics for  a  paradigm,  and  I  have  examined  a  large  number 
of  .them  at  different  periods  under  emotional  influences, 
intense  mental  application,  and  when  their  brains  were  at 
rest,  and  in  each  instance  my  results  varied.  Emotional 
influences  and  intellectual  application  increased  blood - 
pressure,  while  mental  rest  reduced  it.  Blood -pressure  is 
also  influenced  by  physical  activity,  ingestion  of  food,  mens- 
truation, etc.  In  other  words,  blood -pressure,  to  me,  signifies 
nothing  unless  one  takes  into  consideration  the  vaso-motor 
factor. 

Concerning  the  vaso-motor  factor,  the  following  con- 
clusions may  be  formulated :  (i )  Blood -pressure  is  an  expres- 
sion of  action  of  two  chief  factors — ventricular  force  and 
vasoconstriction.  (2  )  The  inhalation  of  amyl  nitrite  dissipates 
the  vasoconstrictor  factor  and  brings  into  play  the  ventric- 
ular force,  which  is  the  real  factor  to  be  encouraged  in  a 
failing  heart.  (3)  The  vasoconstrictor  factor  may  and  does 
compensate  ventricular  inadequacy,  for  it  is  essential  in  most 
cardioarterial  diseases  for  the  blood -pressure  to  be  main- 
tained to  afford  better  nutrition  for  the  heart  and  to  promote 
arterial  elasticity  as  a  means  of  establishing  the  circulation 
of  the  blood.  (4)  The  recognition  of  the  ventricular  and 
vaso-motor  factors  in  blood -pressure  serves  as  a  clue  in  the 
correct  administration  of  cardiotonics. 

VASO-MOTOR  SUFFICIENCY  is  tested  as  follows :  Take  the 
blood -pressure  of  the  individual  first  in  the  recumbent  and 
then  in  the  erect  posture.  Normally  there  is  a  postural 

240 


Blood  Pressure 

variation.  In  the  erect  posture  blood -pressure  rises,  owing 
to  compensatory  arteriole  contraction,  and  this  difference 
between  recumbency  and  standing  varies,  according  to  my 
measurements  with  the  Riva-Rocci  instrument,  between  15 
and  30  mm.  In  vaso-motor  insufficiency  the  postural 
variations  are  reversed,  and  this  is  especially  true  in  neuras- 
thenia, notably,  the  angiopathic  form,  and  in  the  form 
described  by  the  author  as  "splanchnic  neurasthenia,"  where 
the  blood  shows  an  abnormal  tendency  to  accumulate  in  the 
splanchnic  area.  I  regard  a  continuously  maintained  high 
blood -pressure  as  the  most  constant  factor  in  the  etiology  of 
•arteriosclerosis,  and,  further,  consider  that  the  poisons 
absorbed  from  the  intestinal  canal  are  largely  responsible 
for  such  high  tension.  The  latter  factor  is  easy  of  deter- 
mination. 

VASO-MOTOR  METHOD  OF  TESTING  CARDIAC  SUFFICIENCY. — 
As  remarked  before,  blood -pressure  is  the  resultant  of  two 
chief  factors,  viz.,  force  of  the  cardiac  ventricle  and  vaso- 
constriction.  Remove  the  latter,  and  the  ventricular  force 
will  come  into  play.  Blood -pressure  as  taken  ordinarily 
means  nothing,  for  it  is  difficult  to  gauge  how  much  of  it  is 
due  to  the  action  of  the  vaso-motor  nerves  and  how  much  to 
the  condition  of  the  heart-muscle.  The  heart  may  be  very 
weak,  and  yet  show  high  blood -pressure,  because  vasocon- 
striction  compensates  a  failing  heart.  The  method  is,  briefly, 
to  take  blood -pressure  in  the  usual  way ;  next  have  the  patient 
inhale  amyl  nitrite  from  a  bottle  until  the  physiologic  action 
(flushing)  of  the  drug  is  secured,  at  which  time  again  take 
the  blood -pressure.  In  the  norm  the  average  increase  of 
the  pressure  after  the  inhalation  is  from  6  to  10  mm.  In 
cardiac  enfeeblement  there  is  a  fall  instead  of  a  rise  of 
pressure,  and  the  degree  of  fall  is  proportional  to  the  degree 
of  myocardial  insufficiency.  All  my  investigations  were 

241 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

made  with  the  Riva-Rocci  instrument.  Clinicians  have  un- 
reservedly accepted  the  dictum  of  the  physiologist  that  the 
nitrites  lower  the  blood -pressure.  The  latter  may  be  true 
with  toxic  doses,  but  my  clinical  investigations  show  that 
amyl  nitrite  inhalations  will,  in  the  norm,  cause  the  pressure 
primarily  to  fall,  but  the  systolic  pressure  immediately  rises. 
It  has  been  shown  experimentally  that  if  a  nitrite  is  intro- 
duced into  the  cerebral  circulation  and  prevented  from 
attaining  the  general  circulation,  there  is  no  fall  in  the  blood- 
pressure. 

ARTERIOSCLEROTICS,  according  to  my  clinical  observa- 
tions, may  be  classified  as  follows:  (i)  Those  with  high 
blood -pressure  and  strong  cardiac  tones  who  show,  after  amyl 
nitrite  inhalations,  a  stabile  or  a  slight  rise  of  blood -pressure. 
Here  the  cardiac  musculature  is  not  yet  compromised. 

(2)  Those  with  high  blood -pressure  and  enfeebled  cardiac 
tones,  who  show  after  the  inhalation  a  decided  decrease  of 
blood -pressure.     In  this,  as  well  as  the  succeeding  class,  the 
reduction  in  blood-tension  is  influenced  by  the  elimination 
of  the  tonus  of  the  arteries,  which  was  maintained  by  the 
vaso-motor  system  of  nerves,  thus  allowing  the  true  endo- 
cardial  pressure,  which  is  enfeebled,  to  be  brought  into  action. 

(3)  Those  with  relatively  low  blood -pressure  and  enfeebled 
heart  tones  who  demonstrate  a  still  further  reduction  of 
pressure  after  the  inhalation.     In  a  prognostic  sense  the 
latter  class  of  arteriosclerotics  belong  to  the  hopeless  category, 
insomuch  as  the  vaso-motor   system   of  nerves   is  either 
exhausted  or  unable  to  properly  usurp  the  functions  of  a 
failing  heart. 

TEST  FOR  ADMINISTERING  HEART  TONICS. — All  cardiac 
tonics  may  be  divided  into  direct  or  indirect;  the  former 
acting  by  direct  stimulation  of  the  heart;  the  latter,  by 
improving  the  nutrition  of  the  organ  or  by  relieving  vessel- 

242 


Blood 


u 


tension  and  hastening  the  output  of  blood  from  the  heart. 
I  select  a  reliable  infusion  of  digitalis  for  diagnostic  purposes. 
In  the  therapeutic  stadium — i.  e.,  after  its  administration 
for  about  three  days — it  has  a  dual  action,  slowing  the  pulse 
and  augmenting  blood -pressure.  The  latter  is  the  product 
of  two  forces — increased  heart-work  and  augmentation  of 
the  vessel-tone.  Now,  it  is  evident  that  digitalis  may  do  as 
much  harm  as  it  does  good.  Supposing,  before  giving 
digitalis,  we  noted  that  the  blood -pressure  was  218  mm.,  and 
that  after  the  inhalation  of  amyl  nitrite  it  was  reduced  to 
190  mm. ;  that  after  the  use  of  digitalis  it  was  215  mm.,  but 
the  amyl  nitrite  inhalation  reduced  it  to  1 50  mm.  Now,  the 
theory  of  action  of  the  drug  on  the  patient  was  practically  as 
follows:  The  blood -pressure  was  essentially  the  same  after 
as  before  the  use  of  digitalis,  but  while  amyl  nitrite  before  the 
use  of  digitalis  reduced  the  blood -pressure  only  28  mm., 
after  its  use  the  pressure  was  reduced  65  mm.  This  would 
indicate  that  the  digitalis  was  unfavorable  in  its  action,  for, 
after  the  tonus  of  the  blood-vessels  was  removed  by  amyl 
nitrite,  the  greater  reduction  in  blood -pressure  demonstrated 
that  the  cardiac  force  was  further  reduced  after  than  before 
the  use  of  digitalis.  In  other  words,  digitalis  was  goading  a 
jaded  heart,  and  the  high  blood -pressure  was  illusory. 

This  action  is  not  uncommon  in  the  administration  of 
digitalis,  owing  to  its  vasoconstrictor  influence,  and  when  the 
latter  implicates  the  coronary  blood-vessels,  the  nutrition  of 
the  heart  must  suffer.  In  the  case  just  mentioned  digitalis 
showed  an  unfavorable  action,  but  when  it  was  given  in 
combination  with  diuretin,  which  antagonizes  the  vaso- 
constrictor components  of  digitalis,  the  action  of  the  latter 
drug  was  more  favorable,  the  blood -pressure  falling  only 
15  in  lieu  of  65  mm.  Any  of  the  nitrites  may  be  combined 
with  digitalis  or  strychnin  when  the  vasoconstrictor  effects  of 

243 


Spondyloth     e     r    a    p    y 

the  latter  are  undesired.  Strychnin,  like  many  other  drugs, 
has  been  discredited  as  a  heart  tonic  because  clinical  meas- 
urements of  the  blood -pressure  show  no  rise.  The  fact  is 
that  the  vaso-motor  mechanism  which  supplements  the 
cardiac  vigor  increases  the  blood  tension  when  the  latter 
is  enfeebled,  and  diminishes  it  when  the  cardiac  strength  is 
not  involved.  After  adequate  doses  of  strychnin  hypoder- 
matically,  the  vaso-motor  method  of  estimating  pressure 
shows  the  cardiotonic  properties  of  strychnin.  In  all 
instances  cardiac  auscultation  and  sphygmomanometry  are 
necessary  for  estimating  the  action  of  cardiotonics.  The 
sphygmomanometer  only  gauges  the  force  of  the  left  ventricle, 
and  to  determine  the  sufficiency  of  the  right  ventricle, 
auscultation  of  the  cardiac  tones  is  alone  adequate.  The 
cardiac  chambers,  even  in  health,  are  not  constant  as 
far  as  their  diameters  are  concerned ;  on  the  contrary,  they 
contract  and  dilate;  in  other  words,  their  capacity  tends 
to  diminish  with  increasing  cardiac  vigor;  hence  percus- 
sion shows  an  increase  or  diminution  in  the  area  of  cardiac 
dullness  according  to  whether  the  heart  is  insufficient  or 
sufficient. 

SPHYGMOMANOMETRY. 

The  instrument  employed  for  estimating  blood -pressure 
is  called  a  sphygmomanometer  and  it  is  as  essential  to  the 
physician  as  is  his  clinical  thermometer.  All  sphygmomanom- 
eters  are  based  on  the  principal  of  circular  compression 
of  the  arm  by  an  arm -piece,  B  (Fig.  66),  connected  with 
a  manometer  (^4)  and  an  inflating  apparatus  (C).  When 
the  arm-piece  is  sufficiently  tight  to  obliterate  the  pulse  at 
the  wrist,  the  height  of  the  mercury  in  the  manometer 
indicates  the  maximum  systolic  pressure.  With  the  in- 
struments of  Janeway  and  Stanton,  the  diastolic  pressure 

244 


S  p    h    y   g    m    omanometry 

can  also  be  obtained.  The  highest  pressure  in  the  pulse  - 
wave  is  the  systolic;  the  lowest,  the  diastolic;  and  mean 
pressure  signifies  the  average  of  systolic  and  diastolic 
pressures.  For  all  practical  purposes  it  is  sufficient  to  esti- 
mate the  systolic  pressure,  for  it  is  more  often  modified  by 
pathologic  conditions  than  the  diastolic  pressure.  The 
diastolic  pressure  in  a  normal  pulse  is  25  to  40  mm.  below 


FlG.    66. — Sphygmomanometer   of    Riva-Rocci    (Cook's    modification):       A, 
manometer;  B,  arm-piece;  C,  inflating  apparatus. 


the  systolic  pressure,  and  in  high  tension  it  may  be  as  low 
as  50  to  80  mm.  Many  circumstances  modify  our  clinical 
results,  and  certain  precautions  must  "be  taken  with  the  use 
of  all  sphygmomanometers.  All  observations  must  be  made 
with  the  patient  in  the  same  position ;  the  arm-piece  should 
be  applied  at  the  heart-level  and  should  fit  accurately.  A 
wide  arm -piece  (12  cm.)  must  be  employed.  The  con- 
nections must  consist  of  non-distensible  tubing.  It  is,  of 

245 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

course,   better  to  employ  an  instrument  which  measures 
systolic  and  diastolic  pressures. 

The  author  has  frequently  noted  in  his  observations  the 
possibility  of  mistaking  his  own  pulsations  for  those  of  the 
patient.  To  obviate  this  error  in  estimating  blood -pressure, 
he  places  a  rubber  ring  at  the  base  of  his  index  -finger  to 
exclude  the  blood,  and  consequently  the  pulse  from  the 
latter  (Fig.  67). 

TREATMENT  OF  HYPERTENSION. 

The  drugs  employed  for  reducing  a  high  blood -pressure 
are  known  as  vasodilators.  They  produce  paralysis  of  the 
vasoconstrictor  mechanism,  which  is  first  manifested  in  the 


FlG.  67. — Rubber- ring  for  excluding  auto-pulsations. 

face  by  dilatation  of  the  cutaneous  blood-vessels  (blushing). 
The  redness  is  not  confined  to  the  face,  but  may  extend 
over  the  entire  trunk.  With  the  flushing  there  is  also  a  sense 
of  heat,  throbbing  of  the  blood-vessels,  headache,  quickening 
of  the  pulse  and  respiration,  and  ringing  of  the  ears.  The 
veins  are  likewise  dilated.  The  dilatation  of  the  arterioles 
and  veins  of  the  splanchnic  area  leads  to  a  decline  in  the 
general  arterial  pressure.  In  the  administration  of  the 
drugs  of  this  class  one  must  push  them  sufficiently  to  secure 
their  physiologic  effects,  and  then  reduce  the  dose  or  stop 
the  drug  when  the  patient  complains  of  throbbing  or  a 
feeling  of  fullness  in  the  head.  Some  patients  show  a 

246 


High       Blood   -Pressure 

remarkable  idiosyncrasy  to  drugs  of  this  class,  reacting  to 
insignificant  doses,  whereas  others  are  resistant  to  very  large 
doses.  It  is  evident,  then,  that  one  must  begin  with  small 
doses  to  test  individual  susceptibility. 

Among  the  drugs  used  for  lowering  blood -pressure  are 
the  following: 

1.  Amyl  nitrite,  which  is  employed  by  inhalation.     Its 

action  is  manifested  within  fifteen  seconds  and  the 
symptoms  disappear  within  three  minutes. 

2.  Erythrol  tetranitrate  (tetranitrol).    Its  effects  appear 

only  after  an  hour  and  they  last  about  five  hours. 
Dose,  one-half  to  two  grains,  usually  in  tablets. 

3  N  itroglycerin  (trinitr^n).  This  drug  acts  in  about 
two  or  three  minutes,  but  its  effects  only  last  from 
one-half  to  three  hours.  It  is  official  as  a  one  per 
cent  alcoholic  solution;  Spiritus  glycerylis  nitratis, 
dose,  one  to  three  minims. 

4.  Sodium  nitrite,  given  in  doses  of  from  two  to  three 
grains.    It  corresponds  in  rapidity  and  duration  of 
action  to  trinitrin. 

5.  Potassium  iodid,  although  not  an  active  vasodilator, 

clinical  observations  show  that  by  its  prolonged 
use,  a  lowering  of  blood-pressure  may  be  achieved, 
probably  in  consequence  of  its  vasodilator  action. 

6.  High  blood-pressure  is  often  maintained  as  a  result 
of  augmented  tonus  of  the  vaso-motor  center,  and 
is   quite   independent   of  vascular   disease.     It   is 
essentially    a    nervous    phenomenon.     Give    such 
subjects    sufficiently    large    doses    of    bromids   for 
several  days,  and  it  will  be  noted  that  there  is  a 
considerable  fall  in  the  blood-pressure. 

In  the  opinion  of  the  author,  pharmacotherapy  is  not 
always  satisfactory  in  the  treatment  of  hypertension  for  the 
reason  that  toleration  for  the  vasodilators  is  rapidly  acquired 
and  for  the  additional  reason  that  their  action  is  evanescent. 

247 


Spondylotherapy 

From  what  has  preceded,  one  is  justified  in  concluding 
that,  hypertension  is  often  a  condition  which  is  desirable 
and  not  to  be  opposed,  insomuch  as  the  vasoconstriction 
may  compensate  a  failing  heart.  In  such  instances,  vaso- 
constrictors are  injurious  and  the  correct  course  to  pursue  is 
to  strengthen  the  heart  and  the  blood -pressure  will  fall  of 
its  own  accord. 

The  latter  effect  may  be  rapidly  attained  by  concussion 
of  the  spinous  process  of  the  jth  cervical  vertebra  or  more 
slowly  by  the  administration  of  digitalis. 

The  following  case  is  cited  as  a  paradigm  of  many  like 
cases  illustrating  the  preceding  fact. 

A  patient  has  a  blood -pressure  of  240  mm.  Auscultation 
and  percussion  of  the  heart  demonstrate  cardiac  enfeeble- 
ment.  Concussion  of  the  spinous  process  of  the  yth  cervical 
vertebra  is  executed  (duration  of  seance,  5  minutes).  The 
blood -pressure  is  again  taken  and  found  to  have  fallen 
30  mm.  Each  day  thereafter,  concussion  is  executed  and, 
at  the  end  of  about  ten  days,  the  blood -pressure  has  fallen 
to  165  mm.,  the  area  of  cardiac  dullness  is  diminished  and 
there  is  a  decided  strengthening  of  the  heart-tones.  Later, 
in  consequence  of  over-exertion,  an  examination  of  the  heart 
shows  cardiac  enfeeblement  and  the  blood -pressure  has 
risen  to  200  mm.,  but  with  repetition  of  the  concussion  - 
treatment,  the  pressure  falls  to  165  mm. 

Now,  in  a  case  like  the  preceding,  an  examination  of  the 
heart  would  not  have  been  necessary  to  justify  the  conclusion, 
that  the  high  blood -pressure  was  only  an  expression  of 
cardiac  enfeeblement;  estimating  the  blood -pressure  before 
and  after  the  concussion -treatment  would  have  sufficed  to 
warrant  the  deduction. 

Many  erroneous  conclusions  are  formulated  concerning 
the  vigor  of  the  heart  by  aid  of  auscultation.  Here,  it  is 

248 


Hyp  ertension  and  H  y  potension 

assumed,  that  accentuation  of  the  second  aortic  tone  suggests 
vigor  of  the  left  ventricle  of  the  heart,  yet  one  may  hear 
very  loud  heart-tones  in  anemic  and  emaciated  persons. 
The  fact  is,  that  two  factors  contribute  to  the  genesis  of  the 
tones  of  the  heart,  viz.,  muscle  and  valves,  and  it  is  often 
difficult  to  distinguish  the  prolonged  and  dull  sound  of  the 
former  from  the  short  and  sharp  sound  of  the  latter. 

CONCUSSION  IN  HYPERTENSION  AND  HYPOTENSION. 

The  writer  has  established  empirically  that,  one  may 
rapidly  reduce  the  blood -pressure  by  applying  the  concussor 
(large  enough  to  include  two  spinous  processes,  Fig.  50) 
of  a  vibratory  apparatus  yielding  a  forcible  percussion 
stroke  to  the  spines  of  the  2nd  and  yd  dorsal  vertebra  and 
maintaining  the  seance  for  about  five  minutes.  Hundreds  of 
investigations  thus  made  convince  the  author  that,  by  this 
method,  one  is  in  possession  of  a  means  for  reducing  pressure 
heretofore  unattainable  by  pharmacotherapy,  insomuch  as 
the  results  are  more  rapid  and  lasting.  The  following  are 
the  records  of  two  arteriosclerotics : 

1.  Mrs.  W. 

Blood-Pressure  before  vibration  of  the  2nd  and 

3rd  dorsal  spines 225  mm. 

One  minute  after  vibration 218  mm. 

Two  minutes  after  vibration 185  mm. 

Three  minutes  after  vibration 178  mm. 

Fifteen  minutes  after  vibration 180  mm. 

Thirty-five  minutes  after  vibration 178  mm. 

Two  hours  after  vibration 172  mm. 

The  following  day 168  mm. 

2.  Mr.  S.  • 

Blood-Pressure  before  vibration 228  mm. 

Two  minutes  after  vibration 232  mm. 

Five  minutes  after  vibration 210  mm. 

Eighteen  minutes  after  vibration 200  mm. 

249 


S    p     o    n    d    y    I    o     t    h     e    r    a   p    y 

Not  infrequently,  the  primary  result  of  concussion  is 
manifested  by  a  temporary  rise  of  pressure  followed  by  a 
decided  fall  which  attains  its  maximum  in  about  two  hours 
time.  One  must  not  assume,  however,  that  the  results  in 
hypertension  are  always  uniform.  In  some  instances  no 
effect  is  achieved,  and  the  author  is  constrained  to  believe 
that,  in  such  cases,  the  hypertension  is  due  to  cardiac 
enfeeblement,  and  it  is  only  after  toning  the  heart  that  a 
fall  of  blood -pressure  occurs. 

When  the  blood -pressure  is  diminished  in  arteriosclerotics 
by  aid  of  concussion,  it  is  usual  to  find  a  heart  showing 
little  or  no  enfeeblement.  If  there  is  no  fall  of  pressure 
following  concussion  of  the  2nd  and  3rd  dorsal  spines  and 
and  a  fall  is  only  observed  after  concussion  of  the  'jth  cervical 
spine,  the  high  pressure  is  caused  by  cardiac  weakness  and 
concussion  of  the  spine  in  question  is  indicated  to  reduce 
pressure  which  it  does  by  toning  the  heart. 

If  a  patient  has  certain  symptoms  which  one  assumes 
are  caused  by  the  arterial  hypertension,  a  reduction  of  the 
latter  by  the  foregoing  method  (concussion  of  the  2nd  and 
3rd  dorsal  spines  or  yth  cervical  spine)  suggests  the  correct- 
ness of  the  diagnosis  and  the  treatment  conducted  along  the 
same  lines  will  prove  in  a  relative  sense,  curable. 

Thus  in  cerebral  arteriosclerosis,  the  patient  may  have 
headache,  vertigo,  transient  pareses  or  aphasia.  If,  following 
concussion,  there  is  diminished  arterial-tension  and  an 
abatement  of  symptoms,  the  diagnosis  is  suggested. 

LOW  BLOOD -PRESSURE. 

»  (Hypotension.) 

A  systolic  pressure  below  loomm.,  suggests  hypotension 
and  is  observed  in  wasting  diseases,  infections,  hemorrhages, 
collapse  and  shock  and  after  the  use  of  vasodilators. 

250 


Low     Blood-    Pressure 

SUPRARENAL  INSUFFICIENCY. — The  "tache  cerebrate"  is 
a  red  line  with  white  borders  produced  by  drawing  the  nail 
over  the  skin.  It  is  a  vaso-motor  phenomenon  present  in 
typhoid  fever  and  meningitis,  and  is  without  diagnostic 
significance.  Sergent  directed  attention  to  a  "white  line," 
which  is  the  converse  of  the  tache  cerebrate.  Like  the  latter, 
it  is  evoked  by  drawing  the  finger-nail  across  the  abdominal 
skin.  Within  thirty  to  sixty  seconds  a  white  line  appears, 
which  persists  from  two  to  five  minutes.  Sergent  found  the 
line  in  Addison's  disease  and  in  a  number  of  specific  fevers, 
all  of  which  were  characterized  by  low  arterial-tension.  In 
these  cases  he  found  that  the  administration  of  suprarenal 
extract  caused  the  white  line  and  the  low  tension  to  dis- 
appear. He  therefore  regards  this  line  as  useful  in  the 
diagnosis  of  suprarenal  insufficiency  and  in  affections  of 
the  capsules.  Other  French  writers  have  confirmed  this 
observation.  The  white  line  is  caused  by  a  reflex  spasm  of 
the  capillaries,  and  can  be  provoked  in  vasodilatation  and 
in  conditions  of  low  vascular  tension.  There  is  much  reason 
to  question  the  constancy  of  the  white  line  as  a  diagnostic 
symptom.  Thus,  de  Massary  failed  to  observe  the  sign  in 
six  cases  of  Addison's  disease,  even  though  the  arterial 
tension  was  very  low.  Grimbaum  finds  that  the  oral  ad- 
ministration of  suprarenal  extract  to  normal  individuals 
does  not  cause  a  rise  of  blood -pressure,  and  that  when  a  rise 
follows  exhibition  of  the  drug  by  the  mouth,  it  indicates 
suprarenal  inadequacy.  In  doubtful  cases  the  blood -pressure 
is  accurately  determined,  and  then  3-grain  doses  of  the 
extract  are  administered  thrice  daily  for  three  days.  The 
pressure  is  again  estimated,  and  a  distinct  increase  is  very 
suggestive  of  Addison's  disease,  provided  there  is  no  valvular 
lesion  of  the  heart.  Suprarenal  insufficiency  should  be 
tested  whenever  asthenia  and  pigmentation  are  present. 

251 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

The  latter  are  the  chief  symptoms  of  Addison's  disease,  but 
are  likewise  present  in  many  other  diseases.  If  there  is  no 
bronzing  in  Addison's  disease  the  application  of  a  mustard 
plaster  will  draw  the  pigment  to  the  surface  of  the  skin. 

NEURASTHENIA  is  often  associated  with  hypotension,  in 
fact,  it  is  the  only  demonstrable  sign  in  these  cases.  Such 
patients  usually  complain  of  obscure  abdominal  symptoms 
(SPLANCHNIC  NEURASTHENIA)  and  this  is  not  surprising 
considering  the  fact  that  the  loss  of  vaso -mo tor  tone  conduces 
to  a  large  accumulation  of  blood  in  the  abdominal  veins. 

TREATMENT  OF  HYPOTENSION. 

It  is  exceedingly  injudicious  practice  as  a  routine  method, 
to  have  recourse  to  symptomatic  treatment,  but  insomuch  as 
physicians  are  human  and  not  divine,  such  treatment  is 
often  imperative  and  indeed  efficacious,  when  the  causal 
factor  is  not  demonstrable. 

Thus,  in  hypotension,  many  drugs  are  efficient  for 
influencing  collapse  and  the  drugs  used  for  this  purpose  are 
the  following:  Strychnin,  camphor,  caffein,  strychnin  and 
ether. 

The  foregoing  cardio-vascular  stimulants,  however,  are 
only  temporary  in  their  action. 

Much  was  expected  of  adrenalin  in  the  treatment  of 
hypotension,  but,  unfortunately,  disappointment  has  attended 
its  employment. 

This  agent  causes  a  decided  rise  of  blood-pressure,  due 
to  its  vasoconstrictor  action  on  the  blood-vessels  and  by  its 
direct  action  on  the  heart.  It  causes  retardation  and 
strengthening  of  the  heart-beat.  The  vascular  constriction 
is  most  pronounced  in  the  splanchnic  and  muscular  vessels, 
and  feeble  or  absent  in  the  cerebral  and  pulmonary  vessels. 

252 


Low     Blood    -Pressure 

The  renal  vessels  are  first  constricted,  with  diminished  flow 
of  urine,  but  dilate  with  larger  doses  and  increased  flow  of 
urine.  The  augmented  blood -pressure  almost  immediately 
succeeds  the  use  of  the  drug,  but  it  is  of  short  duration.  It 
has  been  found  that  vasoconstriction  is  of  greater  duration 
than  the  rise  of  blood -pressure,  and  this  is  explained  by  the 
fact  that  the  stimulating  effect  on  the  heart  is  of  less  duration 
than  the  stimulating  action  of  the  arterial  musculature. 

The  bath -treatment  of  typhoid -fever  has  demonstrated 
that,  the  water  has  a  decided  hypertensive  action  on  the 
vaso  -motor  system  and  that  it  produces  a  rise  of  the  blood - 
pressure. 

The  latter  result  demonstrates  the  very  pertinent  fact 
that  cold  water  acting  as  a  peripheral  cutaneous  stimulant 
provokes  the  heart  reflex  and,  insomuch  as  the  force  of  the 
ventricular  systole  is  the  primary  factor  in  blood -pressure, 
the  latter  rises. 

Now,  the  author  has  repeatedly  demonstrated  that  there 
are  many  individuals  showing  cardiac  enfeeblement  in  whom 
there  is  no  response  on  the  part  of  the  vaso -mo  tor  mechanism 
to  compensate  the  failing  heart.  Here,  strengthening  of  the 
enfeebled  heart  by  means  of  digitalis  or  by  concussion  of  the 
spine  of  the  yth  cervical  vertebra  results  in  a  rise  of  blood - 
pressure. 

The  author  has  established  empirically  that  concussion 
of  the  spines  of  the  6th  and  jth  dorsal  vertebra  will  raise  the 
blood -pressure.  The  results,  however,  are  not  as  uniform 
as  is  the  method  for  reducing  blood -pressure,  and  not 
infrequently,  the  effects  are  only  noted  after  a  lapse  of  about 
two  hours. 

If  the  latter  method  is  effective,  the  results  are  relatively 
permanent  and  many  neurasthenics  with  hypotension  can 
bear  testimony  to  the  foregoing  statement. 

253 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

The  duration  of  the  seances  is  about  the  same  as  when 
concussion  is  employed  in  hypertension. 

ANEURYSM  OF  THE  THORACIC  AORTA. 
THE  AORTIC  REFLEXES. 

The  course  of  the  upper  surface  of  the  normal  aorta  in 
the  adult  of  middle  life  may  be  projected  on  the  thorax  by 

*•«•  kc. 


FIG.  68. — Relation  of  heart  and  aorta  to  the  chest  wall:    i-io,  ribs;  Ao,  aorta; 
RS  and  RC,  right  subclavian  and  carotid;  LS  and  LC,  left  subclavian  and  carotid. 

drawing  a  curved  line,  beginning  at  a  point  corresponding 
to  the  right  sternal  line  in  the  middle  of  the  first  intercostal 
space  and  ending  at  the  point  of  insertion  of  the  first  left  rib 
to  the  sternum  (Fig.  68).  The  highest  point  of  the  aortic 
arch  is  distant  about  5  cm.,  and  the  beginning  2  cm.,  from 
the  anterior  thoracic  wall,  hence  a  forcible  percussion  blow 
(which  is  propagated  to  a  depth  of  5  cm.)  cannot  fail  to 
elicit  the  dullness  of  the  aortic  arch  if  dilated. 

254 


A 


o     r 


R     e    f    I    e 


In  the  norm,  the  transverse  dullness  of  the  aorta  at  the 
level  of  the  manubrium  extends  2  or  3  cm.  to  the  right  of  the 
median  line  of  the  sternum  and  1.5  to  2.5  cm.  to  the  left  of 
the  medial  line.  If  the  transverse  dullness  at  this  point 
exceeds  5  cm.,  the  aorta  is  either  dilated  or  the  site  of  an 
aneurysm.  The  aorta  is  nearest  the  anterior  chest-wall  at 


FIG.  69. — Aortic  reflex  of  contraction  FIG.  70. — Aortic  reflex  of  contraction, 

and  dilatation.     Front.  and  dilatation.     Back. 

the  junction  of  the  2nd  right  interspace  with  the  sternum. 
From  this  point  as  it  arches  over  to  the  left,  it  sinks  deeper 
into  the  cavity  of  the  thorax  so  that  it  eludes  percussion. 

Concussion  of  the  four  last  dorsal  vertebras  (gih  to  the 
1 2th  dorsal  vertebra)  in  succession,  by  a  series  of  sharp, 
vigorous  blows  will,  in  the  norm,  dilate  the  thoracic  aorta 
which  can  be  demonstrated  by  the  x-rays  and  by  percussion. 
Percussion  must  be  executed  at  once  after  concussion  of  the 
vertebral  spines  in  question,  insomuch  as  the  duration  of 

255 


Spondyloth     e     r    a   p    y 

the  reflex  of  aortic  dilatation  is  limited  (from  one -half  to 
one  minute).  Vibrosuppression  (page  80)  will  aid  in 
defining  the  course  of  the  aorta. 

Concussion  of  the  spine  of  the  *]th  cervical  vertebra  causes 
a  contraction  of  the  thoracic  aorta  (aortic  reflex  of  con- 
traction}. Thus  it  is,  that  when  one  provokes  the  dilatation 
reflex,  the  counter  reflex  of  contraction  will,  at  once,  dissipate 
the  former  reflex. 

Percussion  of  the  vertebral  spines  is  executed  by  means 
of  the  hammer  and  pleximeter  or  the  hands  (Fig.  3). 

THE  AORTIC  REFLEXES  IN  DIAGNOSIS. 

As  before  remarked,  one  is  able  to  define  by  percussion 
the  normal  area  of  the  arch  of  the  aorta  after  concussion  of 
the  four  lower  dorsal  vertebrae.  Thus  it  is,  that  if  the 
diminished  resonance  or  dullness  exceeds  the  norm,  either 
the  vessel  is  dilated  or  it  is  the  site  of  an  aneurysm.  One 
may  remark  that  if  an  aortitis  is  present,  the  reflex  of  dilata- 
tion will  reproduce  the  symptoms  peculiar  to  this  affection, 
viz.,  pains  in  the  upper  sternal  region  extending  through 
the  mediastinum  and  to  the  shoulder  and  arm. 

A  dull  area  in  the  upper  thoracic  region  or  in  the  back 
(corresponding  to  the  site  of  the  aorta),  if  caused  by  a 
thoracic  aneurysm,  will  show  a  diminished  area  of  dullness 
when  the  spine  of  the  yth  cervical  vertebra  is  concussed 
(aortic  reflex  of  contraction),  and  an  increased  area  of  dull- 
ness, when  the  spines  of  the  four  lower  dorsal  vertebrae  are 
successively  concussed  (aortic  reflex  of  dilatation).  Up  to 
the  present  time  of  writing,  the  author  has  examined  45 
cases  of  aneurysm  of  the  thoracic  aorta  and  has  noted  an 
absence  of  the  reflex  in  only  two  patients  in  whom  the 
aneurysms  had  attained  enormous  dimensions.  All  these 
cases  were  controlled  by  skiascopic  examinations.  With 

256 


Aortic     Reflex     of    Contraction 

the  latter,  one  may  note  a  contraction  and  dilatation  of  the 
aneurysmal  sac  when  the  spines  of  the  special  vertebrae  are 
concussed.  One  may  generally  observe  an  almost  immediate 
evanescence  of  pressure -symptoms  (dyspnea,  cough  and 
pains)  when  the  sac  is  brought  to  contraction  after  a  single 
seance  of  vibration -treatment  applied  to  the  spine  of  the 
yth  cervical  vertebra. 

THE  AORTIC  REFLEX  OF  CONTRACTION  IN  TREATMENT. 

It  occurred  to  the  writer  when  he  first  employed  the 
aortic  reflexes  in  diagnosis,  that  if  concussion  of  the  yth 
cervical  vertebra  would  cause  contraction  of  an  aneurysmal 
sac,  this  fact  would  prove  advantageous  in  the  treatment  of 
a  thoracic  aneurysm.  The  results  achieved  have  exceeded 
the  author's  expectations.  Only  fourteen  patients  with 
thoracic  aneurysm  have  thus  far  been  treated  by  the  author 
according  to  his  method,  but  they  were  all  advanced  cases. 
Absolutely  no  results  were  achieved  in  one  case  (the  aneurysm 
had  attained  an  immense  size  and  the  sac  ruptured).  This 
much  may  be  said  for  this  treatment  that  the  results  usually 
follow  after  several  seances  of  the  concussion -treatment. 
The  first  case  of  aneurysm  of  the  thoracic  aorta  thus  treated 
was  seen  in  consultation  with  Dr.  A.  J.  Sanderson,  of 
Berkeley.  The  following  record  is  presented : 

Treatment  was  commenced  July  y,  1905,  on  which  date 
the  patient  complained  of  violent  pains  in  the  chest  and 
dyspnea  on  the  slightest  exertion.  On  August  2,  1905,  the 
x-ray  shadow  of  the  aneurysm  was  denser,  and  the  aortic 
reflexes  could  not  be  elicited.  The  latter  I  attribute  to  clot- 
formation  in  the  aneurysmal  sac,  which  inhibited  whatever 
elasticity  remained  in  the  aortic  walls.  At  this  date  aneurys- 
mal pulsations  could  no  longer  be  detected  by  the  rays. 
Dullness,  formerly  present  over  the  sac  on  the  anterior 
chest-wall  could  no  longer  be  elicited.  Tracheal  tugging 

257 


S  p    o     n    d    y    I    o     t    h     e    r    a    p    y 

was  barely  perceptible.  The  thoracic  pains  had  disappeared, 
and  there  was  no  longer  any  dyspnea  on  exertion.  On  the 
first  of  September,  Dr.  Sanderson  stated  that  the  only 
symptom  which  remained  at  the  time  the  patient  left  his 
home  was  slight  tracheal  tugging.  In  all  my  cases  the  latter 
symptom  persisted  despite  the  disappearance  of  subjective 
symptoms. 

Dr.  Hubert  N.  Rowell,  of  Oakland,  directed  a  patient 
(male,  age  56  years)  to  me,  who  noted  about  four  years 
before  coming,  the  following  symptoms :  Cough,  pressure  in 
the  chest,  dyspnea  and  a  sensation  of  suffocation  when  he 
assumed  the  recumbent  posture.  An  examination  demon- 
strated a  large  aneurysm  of  the  arch  of  the  aorta. 

Just  before  treatment  was  commenced,  the  patient  could 
not  get  more  than  three  hours  sleep  at  night  owing  to 
paroxysmal  attacks  of  coughing  and  choking.  After  the 
first  treatment  he  could  sleep  the  entire  night,  and  after  two 
weeks'  treatment  consisting  of  daily  seances  (five  minutes 
duration)  by  means  of  vibration  applied  to  the  spine  of  the 
yth  cervical  vertebra,  the  patient  was  practically  well  and 
there  was  nothing  to  indicate  the  persistence  of  his  original 
trouble  beyond  a  slight  tracheal  tugging.  During  this  brief 
period  he  gained  ten  pounds  in  weight.* 

Dr.  William  Clark,  of  Alameda,  made  the  following 
notes  concerning  a  patient  whom  he  sent  to  me  for  treatment 
on  February  26,  1909 : 

Miss  G.     Age  30  years;  native  of  California. 

Complains  of  croup  at  night  whenever  she  catches  cold. 

HISTORY:      Measles,   whooping-cough   and  diphtheria; 

typhoid  fever  thirteen  years  ago.    Is  not  sure  about 

scarlet  fever.     Menstrual  history  normal.     About 

*This  patient,  re-examined  after  a  year,  is  absolutely  well  and  shows  an  increase 
in  weight  of  twenty  pounds. 

258 


Aortic     Reflex     of    Contraction 

eight  years  ago  noticed  a  choking  sensation.  This 
becoming  worse,  was  the  reason  for  consultation. 
She  cannot  lie  on  left  side  at  night;  also  is  quite 
short  of  breath  upon  exertion. 

EXAMINATION:  Fairly  developed;  eyes  protruding;  no 
trouble  since  using  glasses;  no  headaches;  has  no 
pain.  Notices  that  voice  is  more  husky  since  I  last 
saw  her.  Is  slightly  dyspneic  at  this  time.  Veins 
on  the  anterior  part  of  the  chest  quite  dilated.  No 
pulsation  over  upper  part  of  chest  noticed.  Exam- 
ination of  lungs  negative.  Spleen  not  palpable. 
An  area  of  slight  dullness  over  upper  part  of  sternum 
and  to  the  right.  Loud  bruit  over  the  arch  of  the 
aorta,  heard  loudest  at  junction  of  the  clavicle  with 
the  sternum  on  the  left  side;  bruit  transmitted  to 
the  subclavian  and  carotids,  more  so  to  the  left; 
is  also  transmitted  along  the  course  of  the  aorta, 
and  is  heard  over  the  abdominal  aorta;  also  heard 
posteriorly  over  the  entire  course  of  the  aorta. 
Radial  arteries  apparently  not  atheromatous.  With 
laryngoscope,  right  vocal  cord  apparently  not  as 
active  as  the  left.  This,  however,  may  be  erroneous, 
as  there  is  considerable  difficulty  in  obtaining  a 
clear  view,  owing  to  position  and  contour  of  epig- 
lottis. No  tracheal  tugging  detected.  Left  radial- 
pulse  possibly  more  forcible  than  right.  With  x- 
ray,  pronounced  pulsation  of  the  arch  of  the  aorta 
noticed,  and  arch  also  noticeably  elongated  in  a 
vertical  line.  Heart  apparently  not  much  enlarged. 

DIAGNOSIS:   Aneurysm  or  dilatation  of  the  aortic  arch. 

This  patient  was  examined  by  the  author  in  association 
with  Dr.  Clark  and  the  percussional  results  elicited  by 
inducing  the  aortic  reflexes  of  contraction  and  dilatation  are 
noted  in  Fig.  71. 

It  was  noted  that,  when  the  aortic  reflex  of  dilatation  was 
provoked,  there  was  a  temporary  aggravation  of  the  dyspnea 

259 


Spondylotherapy 

and  spasmodic  cough,  but  they  were  at  once  subdued  when 
the  aorta  reflex  of  contraction  was  elicited.  Within  several 
days  after  treatment  was  commenced,  all  the  subjective 
symptoms  disappeared  and  after  five  weeks'  treatment  by 
percussion-massage  of  the  spine  of  the  yth  cervical  vertebra 
the  patient  was  practically  discharged.  The  patient's 


FIG.  71. — Aortic  reflexes  of  contraction  and  dilatation  represented  by  the 
clotted  lines  within  and  without  the  continuous  line  (which  represented  the  area 
of  aneurysmal  dullness  before  elicitation  of  the  aortic  reflexes). 

exophthalmos  disappeared  after  a  few  treatments  and  further 
reference  to  this  subject  is  made  on  page  280. 

It  is  unnecessary  to  detail  the  histories  of  the  other  cases 
of  thoracic  aneurysm  beyond  saying  that  the  results  achieved 
corresponded  in  the  main  to  the  cases  cited.* 

*Since  the  above  was  written,  a  gentleman  of  approximately  53  years  of  age  had 
developed  an  attack  of  whooping-cough  which  was  epidemic.  Cough  and 
laryngitis  persisted  for  over  four  months.  Examination  demonstrated  the 
presence  of  an  aneurysm  of  the  thoracic  aorta.  The  question  naturally  arose, 
Was  the  cough  due  to  the  whooping-cough  or  aneurysm  ?  Concussion  of  the 
7th  cervical  vertebra  was  executed  and  it  was  not  until  the  sixth  seance  that  the 
cough  and  laryngitis  abated,  showing  that  the  aneurysm  alone  was  responsible 
for  his  cough.  Unlike  my  other  cases  of  aneurysm,  the  cough  did  not  yield  to 
the  first  concussion-treatment.  Again,  the  aneurysm  as  a  sequela  of  whoop- 
ing-cough is  interesting.  I  had  examined  the  patient  while  under  the  care  of 
Dr.  Grant  Selfridge  in  the  commencement  of  his  attack  of  pertussis  and  found 
absolutely  no  signs  of  an  aneurysm.  The  patient  in  question  had  absolutely 
no  more  attacks  of  coughing  after  the  twelfth  treatment  and  the  area  of 
aneurysmal  dilatation  was  no  longer  evident  by  percussion. 

260 


Aortic     Reflex     of    Contraction 

Now,  a  few  words  are  necessary  respecting  the  method 
of  treatment.  In  the  therapeutic  elicitation  of  the  vertebral 
reflexes,  notably,  the  aortic  reflexes,  the  vibratory  apparatus 
which  the  physician  must  employ  is  one  giving  the  percussion 
stroke.  All  other  motions,  such  as  oscillations,  shaking,  and 
friction  interfere  with  results;  in  other  words,  one  must 
select  an  apparatus  which  percusses.  First,  dust  some  talcum 
powder  over  the  site  of  the  spine  of  the  yth  cervical  vertebra 
to  avoid  irritation  from  any  friction  of  the  pad  connected 
with  the  apparatus;  next,  cover  the  spine  of  the  vertebra 
with  several  layers  of  lint  which  are  attached  to  the  skin  by 
adhesive  plaster.  After  this,  the  percussion  stroke  may  be 
communicated  directly  to  the  spine  of  the  yth  cervical 
vertebra,  or  indirectly,  if  the  skin  is  sensitive  by  interposing 
a  strip  of  linoleum.  The  daily  seances  according  to  results, 
may  last  from  five  to  fifteen  minutes,  but  during  the  seance 
the  treatment  must  be  interrupted  from  time  to  time  to 
avoid  irritation  of  the  skin.  The  latter  may  be  avoided  if 
the  operator  directs  the  patient  to  inform  nim  the  moment 
a  burning  sensation  is  experienced. 

The  author  only  employs  the  pneumatic  hammer  (Fig. 
50)  for  concussion  and,  insomuch  as  there  is  no  friction, 
the  preceding  precautions  are  unnecessary  to  avoid  irritation 
of  the  skin. 

In  the  absence  of  a  suitable  apparatus  one  may  employ 
a  pleximeter  (a  strip  of  linoleum)  applied  to  the  yth  cervical 
spine  which  is  struck  a  series  of  rapid  and  moderate  blows 
by  means  of  a  hammer  to  the  end  of  which  is  fixed  a  large 
piece  of  hard  rubber.  It  is  wise  in  this  method,  to  protect 
the  spinous  process  with  a  thick  layer  of  lint. 

The  author  has  not  the  hardihood  to  regard  his  method 
of  treatment  of  aneurysm  of  the  thoracic  aorta  as  curative, 
for  time  alone  is  the  decisive  factor;  yet  a  conservative 

261 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

estimate  of  the  results  thus  far  achieved  prompts  him  to  say 
that  as  a  palliative  method,  it  surpasses  any  which  has  yet 
been  recommended  to  the  profession. 

The  diagnosis  of  aneurysm  of  the  thoracic  aorta,  despite 
our  physical  methods  of  examination,  is  often  fraught  with 
difficulty,  but  the  latter  is  minimized  if  the  physician  will 
remember  the  following  facts:  Symptoms  suggestive  of  an 
aneurysm  of  the  thoracic  or  abdominal  aorta  are  accentuated 
after  concussion  of  the  spines  of  the  four  lower  dorsal  vertebrae 
and  they  are  mitigated  after  concussion  of  the  spine  of  the 
yth  cervical  vertebra,  although  several  seances  may  be 
necessary  to  note  the  latter  result. 

Further,  an  area  of  percussional  dullness  which  enlarges 
when  the  four  lower  dorsal  vertebrae  are  concussed  and 
diminishes  when  the  spine  of  the  yth  cervical  vertebra  is 
concussed,  suggests  an  aneurysm. 

It  is  reasonable  to  assume  that  an  aneurysm  of  the 
abdominal  aorta  would  be  similarly  influenced  by  the 
maneuvers  suggested,  but  the  author  is  in  the  possession 
of  no  evidence  to  permit  him  to  cite  a  supposition  as  a  fact. 

* 

ANEURYSM  OF  THE  ABDOMINAL  AORTA. 

Since  the  foregoing  was  written,  a  patient  was  referred 
to  me  by  Dr.  E.  N.  Torello.  The  patient  in  question  (male, 
age  65  )  had  excruciating  pains  referred  to  the  abdomen  and 
thorax  for  nearly  a  year,  which  resisted  all  methods  of 
treatment  and  necessitated  the  constant  use  of  analgesics. 
An  examination  revealed  signs  of  arteriosclerosis  and  a 
dullness  in  the  left  lumbar  region ;  the  area  of  dullness  in- 
creased when  the  four  lower  dorsal  spines  were  concussed  and 
diminished  when  the  jth  cervical  spine  was  concussed  (Fig. 
72). 

Beyond  the  latter,  nothing  was  demonstrated,  although 

262 


Abdominal       A 


o    r    t    a 


FIG.  72. — Area  of  dullness  in  aneurysm  of  the  abdominal  aorta.  The  con- 
tinuous line  represents  the  area  of  dullness  before  concussion,  whereas  the  dotted 
line  within  the  latter,  is  the  aortic  reflex  of  contraction  (concussion  of  the  7th  cervical 
spine),  and  the  dotted  line  without,  the  aortic  reflex  of  dilatation  (concussion 
of  the  spines  of  the  four  lower  dorsal  vertebrae).  It  is  interesting  to  observe  that 
the  percussion- sign  in  question  was  the  only  evidence  suggesting  an  aneurysm 
and  the  diagnosis  was  established  later  by  other  signs. 


263 


Spondylotherapy 

the  latter  sign  suggested  an  aneurysm  of  the  abdominal 
aorta.  Some  weeks  later  the  author  again  examined  the 
patient  with  Dr.  H.  Sawyer,  and  a  definite  tumor  could  be 
felt  with  an  expansile  pulsation  and  a  slight  thrill.  The 
diagnosis  having  been  definitely  established,  treatment 
consisting  of  concussion  of  the  spine  of  the  yth  cervical 
vertebra  was  commenced ;  the  daily  seances  lasting  about 
ten  minutes.  After  the  fourth  treatment  the  pains  continued 
with  the  same  intensity  (night  and  day)  as  before,  but  the 
pains  were  strictly  localized  on  the  left  side  of  the  abdomen. 
Until  about  the  tenth  seance,  the  patient  asserted  that  the 
pains  were  not  mitigated.  The  latter  statement  was  dis- 
couraging considering  the  fact  that  in  the  author's  experience, 
the  symptoms  of  thoracic  aneurysm  had  usually  yielded  to 
a  few  .treatments.  After  the  tenth  seance,  however,  the 
pains  gradually  became  less  intense  and  analgesics  were  no 
longer  required. 

There  was  later,  however,  a  decided  interruption  in  the 
improvement  of  the  patient  owing  to  the  fact  that  one 
morning,  after  considerable  straining  at  stool,  the  pains 
recurred  with  almost  the  same  violence  as  before,  but  a 
continuation  of  the  treatment  by  concussion  caused  the 
pains  to  disappear  gradually,  and  at  the  time  of  writing, 
the  patient  is  practically  well.  It  may  also  be  noted,  that 
coincident  with  the  recurrence  of  pain  after  straining  at 
stool,  the  dullness  in  the  left  lumbar  region  was  demonstrable. 
Straining  at  stool  increases  intra-abdominal  pressure  and 
rupture  of  an  aneurysm  is  very  likely  to  occur. 

The  author  wishes  to  emphasize  that  in  all  his  aneurysmal 
patients,  concussion  was  the  only  method  of  treatment  em- 
ployed. Considering  the  results  attained  in  aneurysms  of 
the  aorta,  it  is  not  beyond  the  domain  of  reason  to  hope  for 
like  results  in  aneurysms  of  other  vessels. 

264 


Reflex     of   Abdominal     Aorta 


REFLEX  OF  THE  ABDOMINAL  AORTA. 

The  1 2th  dorsal  spine  corresponds  to  the  aortic  orifice 
in  the  diaphragm  and  also  to  the  celiac  axis.  It  is  known 
that  the  most  frequent  site  of  an  aneurysm  of  the  abdominal 


FlG.  73. — Area  of  dullness  corresponding  to  the  iath  dorsal  vertebra  and 
representing  the  reflex  of  the  abdominal  aorta  after  concussion  the  four  lower 
dorsal  spines  with  the  hammer  and  pleximeter  (Fig.  2).  The  increased  area  of 
the  dullness  represented  by  the  dotted  lines  on  both  sides  suggests  a  dilatation  of 
the  aorta,  whereas  the  irregular  dotted  line  on  one  side  suggests  an  aneurysm. 

aorta  is  just  below  the  diaphragm  in  the  neighborhood  of 
the  celiac  axis.  In  the  norm,  the  area  over  the  i2th  dorsal 
vertebra  and  to  either  side  yields  a  resonance  on  percussion. 
If  one  strikes  in  succession  the  four  lower  dorsal  spines, 
the  normal  resonance  over  the  i2th  dorsal  vertebra  and  to 
either  side  yields  a  dullness  which  in  the  average  subject 
measures  about  5  cm.  (Fig.  73). 

If  the  lumbar  vertebrae  show  resonance  on  percussion 

265 


Spondyloth     e    r    a    p    y 

prior  to  the  elicitation  of  the  aortic  reflex  of  dilatation,  a 
dullness  is  likewise  noted  over  the  four  first  vertebrae  in 
question. 

The  dullness  over  and  to  the  right  and  left  of  the  i2th 
dorsal  vertebra  is  caused  by  distension  of  the  aorta.  It 
persists  for  several  minutes  or  may  be  dissipated  at  once  by 
evoking  the  counter  aortic  reflex  of  contraction  (concussion 
of  the  yth  cervical  spine).  Vibrosuppression  (q.  v.)  will 
accentuate  the  dullness.  If  the  dullness  at  the  i2th  dorsal 
vertebra  exceeds  6  cm.  in  diameter,  one  may  conclude  the 
existence  of  a  dilated  aorta  and,  if  the  dullness  is  irregular, 
an  aneurysm  of  this  vessel  may  be  suspected. 

Since  the  author  has  elaborated  the  reflex  of  the  abdom- 
inal aorta,  he  has  recognized  several  cases  of  abdominal 
arteriosclerosis  (by  the  augmented  area  of  dullness)  and  by 
concussion  of  the  7th  cervical  spine,  he  has  successfully 
treated  the  cases  in  question.* 

In  this  connection  the  author  wishes  to  refer  to  the 
valuable  observation  of  Buch.  According  to  the  latter, 
arterio-sclerotic  abdominal  colic  is  specially  amenable  to 
theobromin  (1.5  to  2  gm.  a  day),  diuretin  (3  to  4  gm.  a 
day)  or  tinct.  strophanthi  (5  to  8  drops  three  times  a  day). 
No  other  form  of  abdominal  colic  is  thus  relieved. 

PHYSIOLOGY  OF  THE  AORTIC  REFLEXES. 

Claude  Bernard's  interesting  observations  advanced  the 
clinical  study  of  vaso-motor  phenomena.  He  found  that 
when  the  sympathetics  in  the  neck  of  a  rabbit  were  cut, 

*Thus  in  one  patient,  the  disease  presented  the  picture  of  a  mucous  colitis.  The 
abdominal  aorta  (elicted  by  the  reflex)  measured  8i  cm.  at  the  I2th  dorsal 
vertebra.  The  attacks  had  resisted  treatment  for  a  year,  yet  three  seances  of 
concussion  of  the  yth  cervical  vertebral  spine,  sufficed  to  ameliorate  the 
attacks  and  they  were  later  inhibited  by  further  treatment.  Concussion  in 
augmenting  the  contractility  of  the  dilated  aorta  merely  contributed  to  the 
value  of  this  vessel  as  a  peripheral  pump,  thus  yielding  a  better  supply  of 
blood. 

266 


Clinical      Observations 

the  blood-vessels  in  the  ear  on  the  corresponding  side  became 
dilated  and  that  if  the  peripheral  ends  were  stimulated,  the 
ear  became  blanched.  Those  who  are  adepts  in  manual 
therapy  find  that  manual  pressure  along  the  vertebral 
column  will  evoke  either  vasoconstriction  or  vasodilation; 
the  former  by  brief  and  the  latter  by  continuous  pressure. 
It  is  evident  that  in  explaining  the  genesis  of  the  aortic 
reflex  of  contraction,  one  is  concerned  with  stimulation  of 
the  vasoconstrictor  nerves,  the  centers  of  which  are  chiefly 
in  the  medulla,  where  they  pass  into  the  cord  and  emerge 
with  the  anterior  roots  as  preganglionic  sympathetic  fibers. 
These  fibers  are  not  only  capable  of  altering  the  caliber  of 
the  vessel,  but  by  means  of  continuous  stimuli  passing  over 
them,  they  maintain  the  tone  of  the  vessels. 

The  aortic  reflex  of  dilatation  is  associated  with  stimula- 
tion of  the  vasodilator  nerves,  the  reflex  centers  of  which  are 
located  in  the  medulla  and  throughout  the  spinal  cord. 
From  the  latter  situation,  they  emerge  with  the  posterior 
spinal  nerves.  The  author  seeks  to  explain  the  aortic 
reflexes  by  either  stimulation  of  definite  vasoconstrictor 
and  vasodilator  nerves  or  their  centers  in  the  cord,  and  he 
has  established  empirically  that  concussion  of  the  yth  cervical 
vertebra  stimulates  the  aortic  constrictor  nerves,  whereas 
the  dilator  nerves  are  excited  by  concussion  of  the  spines  of 
the  four  lower  dorsal  vertebrae. 

THE  PSYCHOLOGY  OF  CLINICAL  OBSERVATIONS. 

When  the  author  published  his  original  communication58 
on  the  subject  of  the  aortic  reflexes,  he  was  the  recipient  of 
many  letters,  the  burden  of  which  represented  the  inability 
of  the  correspondents  to  confirm  the  observations  of  the 
author.  It  was  impossible  to  answer  all  the  communications 
at  that  time  and,  as  this  is  an  opportune  moment,  I  will 

267 


Spondylotherapy 

now  endeavor  to  answer  some  of  them.  One  of  the  most 
eminent  physiologists  in  this  country  protested  that  con- 
sidering the  pathologic  condition  of  the  walls  of  the  aorta 
in  aneurysm  of  that  vessel,  it  could  not  in  consequence  be 
excited  reflexly  to  alternate  contraction  and  dilatation. 
Again,  such  clinical  observations  could  not  be  accepted  unless 
corroborated  by  physiologic  investigations.  No  one  can 
gainsay  the  fact  that  pulsation  is  an  important  sign  of  an 
aneurysm,  and  insomuch  as  this  phenomenon  is  dependent 
on  the  elastic  recoil  of  the  walls,  it  follows,  that  elasticity  of 
the  vessel  is  not  annihilated  in  aneurysm  of  the  vessel.  It 
is  true,  as  the  author  has  frequently  observed,  that  the 
walls  of  the  aneurysm  do  not  contract  nor  dilate  equally 
in  eliciting  the  aortic  reflexes;  in  fact,  there  may  be  no 
perceptible  change  under  the  influence  of  the  reflexes  at  one 
point,  but  a  decided  change  at  another  point,  although  in 
every  instance  some  perceptible  change  was  observed. 
Theoretically,  at  least,  the  aortic  reflex  will  persist  as  long 
as  the  aneurysm  pulsates. 

It  is  now  many  years  since  Langenbeck  employed  ergot 
hypodermatically  in  the  treatment  of  aortic  aneurysms. 
He  argued,  that  this  drug  by  stimulating  muscular  tissue 
produced  vasoconstriction  and  in  this  action  the  cure  of  an 
aneurysm  could  be  effected.  A  storm  of  protest  was  en- 
gendered by  this  suggestion,  his  opponents  declaring  that 
the  middle  coat  of  the  aorta  did  not  contain  sufficient 
muscular  tissue  to  enable  it  to  contract. 

Theoretically,  one  would  suppose  that  because  the  aorta 
is  almost  entirely  composed  of  fibrous  tissue,  it  is  not  likely 
to  possess  any  contractile  power,  but  it  has  such  a  power, 
nevertheless.  In  the  case  of  a  criminal  executed  at  Wiirz- 
burg,  it  was  found  to  contract  by  aid  of  electricity  imme- 
diately after  death.59 

268 


Clinical      Observations 

Even  though  the  physiologist  denies  that  the  aorta  pos- 
sesses contractility  he  must  be  equally  consistent  and  deny 
the  evidence  of  the  x-rays,  which  prove  that  the  pathologic 
as  well  as  the  physiologic  aorta  shows  contractility.  Until 
the  advent  of  the  x-rays  we  accepted  the  statement  of  the 
physiologist  that  the  diaphragm  flattened  with  each  in- 
spiration, but  the  rays  demonstrated  that  its  curve  is  always 
maintained  unaltered,  and  in  its  excursions  it  plunges 
piston-wise  up  and  down.  Physiologists  have  always  taught 
that  the  central  tendon  of  the  diaphragm  is  capable  of  only 
limited  movement  in  respiration,  hence  the  respiratory 
mobility  of  the  heart  is  likewise  restricted.  The  rays,  how- 
ever, disproved  the  fallacy  of  this  contention  as  well  as 
many  others  which  space  will  not  permit  us  to  cite. 

The  clinician  no  longer  regards  the  pronunciamento  of 
the  physiologist  as  apodictic.  We  have  learned  to  discredit 
many  statements  emanating  from  the  laboratory-investigator, 
not  so  much  because  the  observations  of  the  latter  are  faulty, 
but  because  there  is  a  considerable  difference  between  a 
laboratory  and  the  bedside  and  a  guinea-pig  and  patient. 
Many  of  the  facts  derived  from  the  laboratory  suggest  the 
comment  of  the  mathematician  who,  having  demonstrated 
a  new  mathematical  theory,  thanked  God  that  it  could  not 
be  of  the  slightest  utility  to  any  living  soul.  Neither  the 
pathologist  nor  the  physiologist  should  forget  that,  "Path- 
ology is  the  physiology  of  the  sick."  The  presence  of  broncho- 
dilator  as  well  as  bronchoconstrictor  fibers  in  the  vagus 
was  conclusively  established  by  the  physiologic  investigations 
of  Dixon  and  Brodie  in  1903,  yet  the  author  demonstrated 
seven  years  before  by  a  simple  clinical  observation  that  the 
vagus  must  contain  bronchodilator  as  well  as  broncho- 
constrictor  fibers.80 

The  final  court  of  decree  of  the  clinician  is  neither  the 

269 


S  p    ondyloth     e    r    a    p    y 

physiologic  nor  pathologic  laboratory.  To  test  a  given 
function  one  must  compare  it  with  a  like  function  in  indi- 
viduals of  the  same  species.  Thus,  if  the  same  quantity  of 
uric  acid  were  excreted  in  a  mammal  as  is  excreted  in  a 
normal  bird,  it  would  have  to  be  regarded  as  pathologic. 
If  disease  were  wholly  a  question  of  demonstrable  lesions 
then  the  pathologist  would  be  compelled  to  deny  the  existence 
of  the  so-called  functional  diseases.  In  consequence  of  this 
conflict  between  the  laboratory  and  clinical  investigator,  a 
hiatus  has  arisen  which  is  now  occupied  by  clinical  pathology, 
a  branch  which  endeavors  to  conciliate  scientific  and  em- 
pirical medicine.  Several  years  ago,  the  writer  observed 
that  one  could  make  the  record  of  the  pulsations  of  the  head 
and,  furthermore,  that  the  cephalograms  thus  obtained  in 
certain  subjects  were  pathognomonic  of  cerebral  arterio- 
sclerosis. Investigating  this  subject  further  in  the  physio- 
logical laboratory  of  the  University  Hospital,  London,  and 
in  Paris,  the  writer  did  not  obtain  the  slightest  clue  to  the 
cephalic  pulsations  and  he  questions,  whether  he  is  justified 
in  rejecting  a  clinical  observation  which  does  not  permit 
of  physiologic  demonstration  in  animals.  One  vituperator 
condemned  my  method  of  treating  aneurysms  as  absurd, 
because  it  was  not  responsive  to  reason.  My  vituperator 
recalled  the  erudite  German  professor  of  economics  who 
received  a  bed  as  a  present.  Until  the  small  hours  of  the 
morning  he  busied  himself  with  abstruse  calculations  to 
determine  whether  he  was  large  enough  for  the  bed  or  if  the 
latter  were  large  enough  for  him.  Finally,  he  was  struck 
with  the  happy  idea  of  getting  into  the  bed,  and  to  his  intense 
delight  discovered  that  it  was  admirably  suited  to  his  pro- 
portions. If  my  detractor  were  endowed  with  the  true  scien- 
tific spirit,  he  would  not  have  condemned  a  new  method  of 
treatment  without  a  trial,  considering  the  kaleidoscopic 

270 


Clinical      Observations 

changes  constantly  arising  in  all  branches  of  science  The 
scientist  rejoices  one  day  at  the  birth  of  a  new  theory  and  of- 
ficiates at  its  burial  on  the  morrow.  In  1903,  in  several  issues 
of  ^The  London  Lancet"  a  discursive  polemic  was  agitated 
on  the  subject  of  my  "lung  reflex."  It  was  quite  evident 
that  one  of  the  disputants  did  not  rigorously  execute  the 
method  for  eliciting  the  reflex  in  question  but  failed  to  cite 
this  reason  for  condemning  it,  although  others  employed 
the  reflex  as  a  clinical  sign  of  value.  Many  new  methods 
for  a  like  reason  have  been  relegated  to  oblivion.  Some 
time  ago,  while  in  Paris,  the  writer  found  several  clinicians 
who  elicited  the  heart  reflex  as  a  routine  method  of  exam- 
ination and  appeared  quite  content  with  the  sign.  The 
writer  demonstrated  that  the  sign  as  elicited  was  of  no 
value,  insomuch  as  when  the  precordial  region  was  stimu- 
lated, it  likewise  evoked  the  lung  reflex  which  also  dimin- 
ished the  area  of  cardiac  dullness,  and  that,  in  consequence, 
one  could  only  rely  on  the  deep  area  of  cardiac  dullness 
as  an  index  of  myocardial  retraction.  A  prominent  Eastern 
clinician  spent  several  days  at  the  author's  office  inves- 
tigating visceral  reflexes.  One  of  the  patients  submitted 
had  an  aneurysm  of  the  thoracic  aorta.  Here  the  aortic 
reflexes  were  the  object  of  study.  It  was  impossible  to 
convince  the  clinician  that  there  was  any  modification  of 
the  area  of  dullness  after  the  elicitation  of  the  reflexes, 
until  the  writer  compelled  him  to  close  his  eyes  while  per- 
cussing, when  the  results  of  percussion  tallied. 

The  author  regrets  the  necessity  of  obtruding  his  per- 
sonality in  the  discussion  of  this  subject,  but  considering 
the  theoretic  objections  to  his  method  of  treatment,  he  feels 
that  any  merit  attached  to  it  may  be  obscured  by  its 
simplicity. 


271 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

THE  VASO -MOTOR  APPARATUS,  f 

The  muscular  walls  of  the  blood-vessels  (arteries, 
veins*  and  capillaries)  are  under  the  control  of  the  vaso- 
constrictor and  vasodilator  nerves.  The  latter  act  chiefly 
on  the  walls  of  the  small  arteries  (arterioles).  If  the  vaso- 
constrictor nerves  are  stimulated,  the  arterioles  contract 
and,  in  consequence,  the  resistance  to  the  flow  of  blood  is 
augmented,  the  pressure  in  the  arteries  rises  and  the  cap- 
illary and  venous  pressures  fall.  A  contrary  effect  is 
produced  on  stimulation  of  the  vasodilator  nerves.  The 
nervous  mechanism  presiding  over  vascular  tone  concerns 
itself  with  the  following: 

1.  Ganglia  of  the  blood-vessels;  example:  pallor  from 

cold  and  hyperemia  from  heat. 

2.  Anomalies   of  the   sympathetic   ganglia;   example: 

facial  hyperemia  in  lesions  of  the  cervical  ganglia. 

3.  Reflex  action   through   the  spinal  cord;  example: 

pallor  from  pain. 

4.  Reflex  action  through  the  medulla  oblongata;  ex- 

ample: glycosuria  subsequent  to  sciatica. 

5.  Impulses  from  the  cortex  of  the  brain;  example: 

blushing. 

The  splanchnic  area1  is  most  abundantly  supplied  with 
vaso-motor  nerves  and  it  is  this  region  which  is  specially 
concerned  in  the  distribution  of  blood  and  the  general 
blood -pressure. 

*Mall  has  shown  that  stimulation  of  the  splanchnics  will  cause  contraction  of 
the  portal  system  and  thus  send  twenty-seven  per  cent  of  the  total  quantity 
of  blood  in  an  animal  into  the  right  heart. 

fThis  subject  is  further  discussed  on  page  278. 

tThe  splanchnic  area  includes  the  vessels  supplied  to  the  intestinal  tract,  liver, 
kidneys  and  spleen. 

272 


Vaso-Motor     Apparatus 

In  the  norm,  by  aid  of  the  regulatory  mechanism  of  the 
vaso-motor  nerves,  each  part  of  the  body  receives  an  amount 
of  blood  necessary  for  its  activity  and  the  greater  the  latter, 
the  more  blood  it  will  receive  in  consequence  of  vasodilation. 
Simultaneously,  the  vessels  in  other  parts  of  the  body  are 
contracted,  and  it  is  by  this  vascular  reciprocity  between 


FIG.  74. — Illustrating  the  path  of  a  vasoconstrictor  nerve;  A,  anterior  root, 
showing  the  course  of  the  preganglionic  fiber  as  a  dotted  line;  D.V.,  dorsal  and 
ventral  branches  of  the  spinal  nerve;  R,  ramus  communicans;  G,  sympathetic 
ganglion.  The  postganglionic  fibers  in  each  ramus  come  from  the  sympathetic 
ganglion  with  which  it  is  connected.  The  preganglionic  fibers  entering  at  any 
ganglion  may  pass  up  or  down  to  end  in  the  cells  of  some  other  ganglion  (Howell). 


the  different  regions,   that  the  normal  blood -pressure  is 
maintained. 

Vasoconstrictor  or  dilator  effects  may  be  produced  at 
the  periphery  by  means  of  vaso-motor  reflexes.  Thus,  if  the 
right  hand  is  immersed  in  cold  water,  the  temperature  falls 
in  the  left  hand,  and  one  also  observes  the  red  cheek  on 
the  implicated  side  in  pneumonia.  The  vaso-motor  reflex 
consists  of  sensory  impulses  which  enter  the  spinal  cord 
with  the  posterior  nerve -roots  and  by  irritating  the  centers 
in  the  cord  excite  constrictor  or  dilator  effects.  The  cells 
of  the  vesicular  columns  of  Clarke  are  supposed  to  be  the 
seat  of  the  reflexes  in  question. 


273 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

THE  VASOCONSTRICTOR  NERVES. 

The  vasoconstrictor  nerves  which  supply  the  skin, 
trunk  and  extremities,  emerge  from  the  ganglion  (Fig.  74) 
to  the  corresponding  spinal  nerve  by  way  of  the  gray  ramus, 
and,  after  attaining  the  spinal  nerve,  they  accompany  it  to 
its  corresponding  region. 

The  chief  center  for  the  vasoconstrictor  nerves  is  in  the 
medulla,  but  throughout  the  entire  length  of  the  spinal 
cord  (excepting  the  cervical  region  and  lowest  part  of  the 
lumbar  region),  there  are  subsidiary  centers. 

The  majority  of  the  vasoconstrictor  nerves  emerge  from 
the  central  nervous  system  in  the  anterior  nerve-roots. 

The  following  table  shows  the  location  of  the  vasocon- 
strictor neural  cells  in  the  segments  of  the  cord : 

DISTRIBUTION.  ORIGIN. 

Brain,  face,  scalp,  mucosa  of  the  2nd,  3rd  and  4th  dorsal  segments. 

nose,  mouth,  salivary  glands, 

ear  and  eye. 

Esophagus  and  stomach.  4th  to  the  Qth  dorsal  segments. 

Small  intestines.  6th  dorsal  to  the  2nd  lumbar. 

Liver.  6th    dorsal    to    the    ist    lumbar 

(chiefly  in  the   xoth,   nth  and 
1 2th  dorsal). 

Pancreas,  spleen  and  suprarenals.  8th  to  the  i2th  dorsal. 

Large  intestines.  nth   dorsal  to  the  2nd  lumbar. 

Bladder,  uterus,  external  organs  nth    dorsal    to    the    2nd   lumbar 

of  generation,  ovaries,  testicles  segments. 

and  prostate  gland. 

THE  VASODILATOR  NERVES. 

These  nerves  are  characterized  as  follows: 

i.     The  latent  period  for  their  stimulation  is  longer  than 
that  of  the  constrictors. 

274 


Vaso-Motor    Neuroses 

2.  It  takes  a  longer  time  to  attain  the  maximum  effects 
on  the  dilators  than  it  does  on  the  constrictors. 

3.  The  after-effect  is  longer. 

4.  The  vasodilators,  unlike  the  vasoconstrictors,  are  not 
in  tonic  activity  and  they  appear  in  activity  only 
during  the  functional  activity  of  an  organ  as  in  the 
case  of  the  erectile  tissue  of  the  penis. 

The  vasodilator  neural  cells  supplying  the  blood-vessels 
of  the  head,  scalp,  face,  eye  and  mouth  are  chiefly  located 
in  the  nuclei  of  the  cranial  nerves.  The  vasodilator  cells 
for  the  abdominal  organs  are  found  in  the  nucleus  of  the 
loth  cranial  nerve  and  for  the  pelvic  organs  and  the  testicles 
in  the  3rd,  4th  and  5th  sacral  segments  of  the  cord.  Vaso- 
constrictor and  vasodilator  cells  for  the  nutrient  blood- 
vessels of  the  lungs  and  bronchial  tubes  (bronchial  arteries), 
have  been  located  with  a  degree  of  certainty  in  the  3rd  to 
the  yth  dorsal  segments  of  the  cord. 

PATHOLOGY  OF  THE  VASO-MOTOR  NERVES. 
(VASO-MOTOR  NEUROSES.) 

A  vasomotor  neurosis  is  expressed  either  as  a  spasm  of 
the  vessels  (angiospasm)  or  less  often  as  a  paralysis  (angio- 
paralysis). 

ANGIOSPASM  is  characterized  by  pallor,  coldness  and 
trophic  disturbances.  If  the  spasm  affects  the  superficial 
vessels,  the  following  symptoms  occur :  sensory  disturbances 
(tingling,  anesthesia  and  analgesia)  and  cutis  anserina 
(goose-skin).  When  the  spasm  involves  larger  vessels,  one 
observes  the  condition  known  as  intermittent  daudicatiou,  in 
which  the  patient  in  walking  suddenly  loses  the  power  in 
his  legs. 

Cases  of  temporary  aphasia,  numbness  and  paralyses 
are  provoked  by  a  like  angiospasm  of  the  cerebral  vessels. 

275 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

The  veins  may  likewise  be  implicated  in  a  spasm  and 
the  blood,  not  being  able  to  escape  from  the  capillaries,  the 
parts  become  blue  and  edematous,  nutrition  is  impaired 
and  gangrene  may  ensue. 

ANGIOPARALYSIS  may  be  caused  either  by  diminished 
function  of  the  vasoconstrictor  nerves  or  by  excessive  action 
of  the  vasodilators.  The  symptoms  are  similar  to  those 
observed  in  spasm  of  the  veins  (vide  supra).  In  the  con- 
dition known  as  causalgia,  the  blue,  cold  and  edematous 
part  is  associated  with  severe  pains  of  a  burning  character. 

In  the  condition  known  as  erythromelalgia,  pain,  tender- 
ness and  congestion  of  the  soles  of  the  feet  are  associated 
with  a  burning  pain  not  unlike  that  produced  by  a  blister. 
The  vaso-motor  phenomena  occur  paroxysmally  and  are 
resistant  to  treatment. 

Another  vaso-motor  neurosis  is  the  so-called  angioneurotic 
edema,  in  which  there  is  a  sudden  swelling  of  some  part 
(face,  neck,  larynx  or  an  extremity). 

Loss  of  vascular  tone  is  observed  in  neurasthenia,  hysteria 
and  at  the  menopause;  there  are  sudden  flushes  or  pallor. 

Individuals  with  a  "poor  circulation"  have  cold  hands 
or  feet  or  the  face  is  constantly  congested. 

We  have  also  the  less  understood  visceral  angioneuroses 
characterized  by  hyperemia,  transudations  and  ecchymoses. 

There  is  an  old  Latin  aphorism,  "Naturam  morborum 
curationes  ostendunt"  (cure  shows  the  nature  of  diseases). 
In  this  sense,  the  pathology  of  many  diseases  is  revealed  by 
the  results  of  treatment.  In  accordance  with  the  preceding 
aphorism,  the  author  contends  that,  there  are  many  diseases 
regarded  as  distinct  affections  which  are  merely  symptomatic 
of  a  fundamental  condition,  viz.,  instability  of  the  nervous 
mechanism  which  controls  local  vascular  tone.  This  faulty 
mechanism,  which  the  author  is  pleased  to  call  angio-ataxia, 

276 


A     n     g     i     o     p     a     r     a     lysis 

has  already  been  referred  to  on  page  275.  It  is  reasonable 
to  assume  that  the  chief  dereliction  of  action  of  this  mech- 
anism is  resident  in  the  vaso-motor  centers  of  the  spinal  cord. 
The  author  submits  the  following  classification  of 
angioneuroses  based  on  the  results  of  treatment : 

ANGIOSPASM. 

Symptoms:  no  vaso-motor  reflex  on  irritation,  skin 
shrunken  or  thrown  into  folds,  arrested  metabolism  and 
function  due  to  insufficient  blood-supply  and  sensory  dis- 
turbances (numbness,  tingling,  anesthesia  and  analgesia). 

ANGIOSPASTIC  AFFECTIONS,  i,  intermittent  claudication ; 
2,  temporary  paroxysms  of  paralysis,  aphasia  or  hemianopsia 
due  to  spasm  of  the  cerebral  vessels ;  3,  reflex  spasm  of  the 
vessels  of  the  leg  in  sciatica,  Nothnagel  has  reported  five 
cases  of  the  latter  affection  which  eventuated  in  partial 
paralysis,  sensory  disturbances  and  atrophy;  4,  Raynaud's 
disease;  5,  migraine;  6,  akroparesthesia. 

ANGIOPARALYSIS. 

Symptoms :  red  or  mottled  appearance  of  the  skin,  sub- 
jective sensation  of  heat,  sensory  disturbances  (hyperesthesia 
and  hyperalgesia),  notably,  a  burning  sensation  (causalgia). 
The  primary  symptoms  of  redness  and  heat  are  usually 
succeeded  by  blueness,  cold  and  impaired  nutrition.  The 
laches  cerebrates  of  Trousseau,  formerly  regarded  as  path- 
ognomonic  of  meningitis,  is  essentially  an  angioparalysis  in- 
dicating enfeebled  vasoconstrictor  action.  The  sign  is 
elicited  by  slight  irritation  of  the  skin  with  the  finger-tip  or 
a  pencil ;  a  white  line  appears  followed  by  a  bright  red  dis- 
coloration which  persists  for  several  minutes.  Dermato- 
graphism  is  closely  related  to  the  foregoing  sign :  wheals  in 
lieu  of  a  white  spot  or  line  appear  after  cutaneous  irritation. 

277 


Spondyloth     e     r    a   p    y 

ANGIOPARALYTIC  AFFECTIONS:  i,  erythromelalgia ;  2, 
acrodynia;  3,  aneurysm;  4,  exophthalmic  goitre;  5,  diabetes; 
6,  coryza;  7,  cold  extremities;  8,  angioparalytic  symptoms 
of  the  neuroses;  9,  certain  toxic  conditions. 

Some  of  the  foregoing  conditions  will  be  described  more 
fully  under  treatment  of  the  vaso-motor  neuroses. 

TREATMENT  OF  THE  VASO-MOTOR  NEUROSES. 

The  author  presents  the  following  table  of  the  vaso-motor 
nerves  in  relation  to  the  spinous  processes,  the  object  being 
to  stimulate  clinical  observations  in  the  treatment  of  the 
vaso-motor  neuroses  which  is  conceded  to  be  a  difficult 
matter : 

ORIGIN  OF  THE  VASOCONSTRICTOR  NERVES. 

AREA  SUPPLIED.  DERIVATION.  RELATION  TO  SPINOUS 

PROCESSES. 

Head.  First  three  dorsal  nerves.         6th  and  7th  cervical  spines. 

Arm.  Seven  upper  dorsal  nerves.       6th   cervical   spine   to  the 

4th  dorsal  spine. 
Leg.  Five  lower  dorsal  and  first     5th  to  the  yth  dorsal  spine. 

lumbar  nerves. 
Abdominal  Viscera.  Splanchnic  nerves  which  are     and  to  the  8th  dorsal  spine. 

made  up  of  fibers  from 

the  5th  to  the  i2th  dorsal 

nerves  inclusive. 

ORIGIN  OF  THE  VASODILATOR  NERVES. 

AREA  SUPPLIED.  DERIVATION.  RELATION  TO  SPINOUS 

PROCESSES. 
Buccofacial  region.  2nd  to  5th  dorsal  nerves.         6th    cervical    to    the    2nd 

dorsal  spine. 
Eye,  head  and  ear.  8th  cervical  and  ist  dorsal     6th  cervical  spine. 

nerves. 
Arm.  Five  upper  dorsal  and  last     5th  cervical  to  and  dorsal 

cervical  nerves.  spine. 

Leg.  6th    to    the     lath    dorsal     3rd  to  the  8th  dorsal  spine, 

nerves,   inclusive. 

In  the  experience  of  the  author  the  foregoing  table  is  of 
slight  value  in  treatment  with  relation  to  the  vasoconstrictors 
of  the  head,  arm  and  abdominal  viscera  (page  349),  but  it 

278 


Vaso-Motor    Neuroses 

serves  of  no  value  in  influencing  the  vasodilators  in  treat- 
ment. 

In  eliciting  the  aortic  reflexes  (page  254),  vasoconstriction 
of  the  aorta  is  best  attained  by  concussion  of  the  *jth 
cervical  spine  and  vasodilation,  by  concussion  of  the  spines  of 
the  four  lower  dorsal  'vertebra. 

The  author  has  found  that  the  same  rule  holds  good  for 
practically  all  the  vessels  of  the  body,  and  this  fact  simplifies 
the  treatment  of  thevaso-motor  neuroses.  Of  all  the  methods 
investigated  by  the  author  for  influencing  the  vaso-motor 
centers  in  the  spinal  cord,  no  method  is  comparable  to  that 
of  concussion;  in  fact,  it  is  the  only  method.  Even  in  the 
norm,  if  concussion  is  executed  over  the  yth  cervical  spine, 
usually  within  a  minute,  vasoconstriction  as  evidenced  by 
some  pallor  is  noted  in  the  hands,  face  and  feet,  whereas 
concussion  of  the  four  lower  dorsal  spines  overcomes  the 
constriction  and  redness  and  even  congestion  substitutes  the 
pallor.  These  effects  are  more  conspicuous  when  there  is 
a  diminished  function  of  either  the  constrictors  or  dilators. 
Naturally,  the  conspicuity  of  pallor  or  redness  is  merely 
relative,  and  one  must  look  sharply  for  the  change. 

The  author  has  treated  a  very  large  number  of  patients 
with  vaso-motor  instability  (angio-ataxia)  and,  when  the 
affection  was  characterized  by  angiospasm,  the  four  lower 
dorsal  spines  were  concussed,  whereas  in  angioparalyses, 
concussion  of  the  yth  cervical  spine  was  executed. 

Results  were  achieved  in  practically  all  instances  after 
repeated  treatment,  provided  a  reaction  could  be  elicited, 
i.e.,  when  concussion  of  the  yth  cervical  spine  would  replace 
hyperemia  by  anemia,  and  when  concussion  of  the  spines 
of  the  four  lower  dorsal  vertebrae  would  substitute  hyperemia 
for  anemia. 

Very  often  the  reaction  could  not  be  noted  until  after 
several  treatments. 


Spondylotherapy 

MIGRAINE  (hemicrania ;  sick  headache). — The  pathology 
of  this  disease  is  obscure  and  the  innumerable  affections  to 
which  its  origin  has  been  attributed  probably  act  as  exciting 
factors  of  a  basic  condition,  viz.,  angio-ataxia.  Many 
writers  regard  migraine  as  a  vaso-motor  neurosis;  in  fact,  a 
former  classification  of  two  varieties  of  the  affection  is  no 
longer  viewed  with  tolerance  by  clinicians:  i,  an  angio- 
spastic  form  characterized  by  pallor  of  one  side  of  the  face ; 
2,  an  angioparalytic  form,  manifested  by  redness  of  one  side 
of  the  face.  Those  who  support  the  vaso-motor  theory  of 
migraine  contend  that  the  early  symptoms  are  caused  by 
vasoconstrictor  and  the  later  symptoms  by  vasodilator 
influences.  The  author  has  treated  about  eight  cases  of 
migraine  by  concussion  of  the  yth  cervical  spine  based  on 
the  theory  of  instability  of  the  vaso-motor  center  in  the  spinal 
cord.  The  attacks  were  subdued  in  four  cases,  relieved  in 
two  patients  and  the  attacks  in  two  other  patients  were  un- 
influenced. The  treatment  must  be  executed  in  the  inter- 
paroxysmal  periods. 

EXOPHTHALMIC  GOITRE  (Grave's,  Basedow's  or  Parry's 
disease). — This  disease  is  characterized  by  protrusion  of  the 
eyes  (exophthalmos),  enlargement  of  the  thyroid  gland, 
tremor  and  rapid  heart-action  (tachycardia).  The  theory 
which  has  gained  most  favor  in  explaining  the  symptoms  of 
the  disease  is,  that  it  is  caused  by  a  hypersecretion  (hyper- 
thyroidism)  of  the  thyroid  gland  conducing  to  a  kind  of 
chronic  intoxication.  There  is,  however,  a  gap  in  the  theory 
which  evades  the  question,  What  causes  the  hyperthyroidism  ? 
Based  on  the  results  of  his  treatment,  the  author  is  con- 
strained to  believe  that  the  disease  is  essentially  an  angio- 
paralytic affection  and  that  stimulation  of  the  vaso-motor 
center  in  the  cord  by  concussion  of  the  yth  cervical  spinous 
process  suffices  to  relieve  and  even  cure  the  affection  in 

280 


Vaso-Motor    Neuroses 

question.  Every  successful  method  of  treatment  in  this 
disease,  medical  or  surgical,  has  been  directed  toward  a 
reduction  in  the  size  of  the  thyroid  gland,  and  it  is  reasonable 
to  assume  that  one  can  stimulate  or  diminish  the  activity  of 
this  gland  by  increasing  or  diminishing  its  circulation. 

Among  the  symptoms  which  yield  most  rapidly  to  treat- 
ment by  concussion  are  tachycardia,  flushing  and  tremor. 
Among  six  cases  of  the  disease  treated  by  the  author  the 
latter  signs,  plus  the  enlarged  thyroid,  were  improved  after 
a  few  treatments  by  concussion,  but  the  exophthalmos  in  all 
but  two  cases  persisted  (although  less  pronounced).  In  all 
the  cases,  a  decided  retraction  of  the  protruded  eyes  was 
noted  after  each  treatment. 

The  following  notes  concerning  one  patient  suffice  to 
illustrate  in  the  main  the  results  of  treatment : 

The  patient  presented  all  the  cardinal  symptoms  of 
the  disease.  The  pulse-rate  was  160;  tremor  involved 
practically  every  muscle  of  the  body;  the  slightest  exer- 
tion was  associated  with  perspiration;  the  thyroid  was 
enlarged. 

After  the  third  treatment  by  concussion,  the  pulse 
was  130,  and  after  the  eighth  treatment,  it  was  reduced 
to  88,  and  so  remained  after  the  patient  was  discharged. 
After  the  fifth  treatment,  the  tremor  was  perceptibly 
diminished  and  perspiration  following  exertion  no  longer 
occurred.  As  shown  in  illustrations  (Figs. 7 5, 7 6), although 
the  exophthalmos  persisted,  it  was  less  conspicuous, 
whereas  the  thyroid  gland  is  practically  normal  in  size.  ' 

DIABETES  MELLITUS. — The  pathology  of  this  disease  is 
obscure.  In  the  celebrated  piquire  experiment  of  Claude 
Bernard,  diabetes  in  an  animal  can  be  produced  by  irritating 
the  floor  of  the  4th  ventricle.  Since  then  it  has  been  shown 
that  irritation  of  other  parts  of  the  nervous  system  will 

281 


produce  diabetes.    In  consequence  of  the  preceding,  there 
has  arisen  a  neurotic  theory  of  diabetes  which  supposes  it 


FIG.   75. — Photograph  of  a  patient  with  exophthalmic  goitre. 

to  be  caused  by  a  vaso-motor  paralysis,  resulting  in  a  greater 
quantity  of  blood  flowing  through  the  liver. 

The  author,  giving  credence  to  the  latter  theory,  has 

282 


Vaso-Motor    Neuroses 

treated  ten  diabetics  by  concussion  of  the  spine  of  the  yth 
cervical  vertebra*  and  the  results  were  as  follows : 


FIG.    76. — Same   patient   after   three    weeks   treatment    (concussion   of    the 
spine  of  the  yth  cervical  vertebra). 

1.  No  results  in  three  cases. 

2.  The  percentage  of  sugar  very  much  reduced  in  four 

cases. 

*The  author  wishes  to  emphasize  the  following:  In  testing  the  methods  of  treat- 
ment employed  throughout  this  book,  recourse  was  had  to  no  other  therapeutic 
procedure.  Not  even  rest,  so  essential  in  the  treatment  of  aneurysm,  was 
enjoined. 

283 


Spondylotherapy 

3.  Slight  reduction  in  the  percentage  of  sugar  in  one 
case. 

4.  Disappearance  of  glycosuria  in  two  cases.     The 
duration  of  treatment  in  the  latter  cases  extended 
over  a  period  of  one  and  two  months  respectively. 

CORYZA  (Cold  in  the  Head). — The  prevention  and 
treatment  of  this  condition  is  a  constant  rebuke  to  progressive 
medicine,  insomuch  as  we  have  added  nothing  to  that  con- 
tributed by  our  medical  ancestors.  The  sequelse  of  a  cold 
in  the,  head  include  affections  ranging  from  sinusitis  to 
cerebral  abscess.  The  prevailing  theory  regards  coryza  as  a 
nasal  infection  varying  in  virulency  according  to  the  microbal 
cause.  If,  however,  it  were  wholly  an  infection,  then  in  a 
region  so  accessible  to  the  employment  of  bactericides,  the 
latter  must  be  discredited.  The  infectious  factor  must  be 
regarded  in  the  same  light  as  any  other  peripheral  irritant 
which,  acting  reflexly  upon  the  vaso-motor  center,  causes  all 
the  symptoms  of  an  angioparalysis.  This  angioparalysis 
need  not  necessarily  be  excited  from  the  nasal  mucosa  but 
from  other  vulnerable  areas.  The  vaso-motor  theory  of 
coryza  is  partially  sustained  by  the  author's  method  of 
treatment,  viz.,  concussion  of  the  jth  cervical  spine.  When 
the  latter  is  executed  in  the  incipiency  of  the  affection,  it 
may  be  aborted.  Later,  it  modifies  the  condition  either  by 
diminishing  its  severity  or  by  altering  the  character  of  the 
discharge. 

When  the  nose  is  obstructed  in  consequence  of  congestion 
of  the  nasal  mucosa,  a  few  concussion-blows  on  the  spine 
of  the  yth  cervical  vertebra  will  often  overcome  the  obstruction 
as  effectually  as  cocain,  and  the  relief  thus  obtained  may 
last  from  minutes  to  hours. 

Very  often  the  author  instructs  a  friend  of  the  patient  to 
strike  the  spinous  process  (after  the  manner  shown  in  Fig 

284 


Vaso-Motor    Neuroses 

3),  whenever  the  nose  is  obstructed  or,  to  execute  it  as  a 
method  of  treatment,  several  times  a  day. 

Naturally,  the  spinous  process  will  become  sensitive 
when  concussed  repeatedly  and,  in  this  event,  it  may  be 
struck  at  different  angles — directly  or  on  one  side  or  the 
other. 

In  asthma,  reflexly  provoked  by  congestion  of  the  nasal 
mucosa,  concussion  as  cited  by  giving  immediate  relief  to 
the  nasal  congestion  will  inhibit  the  asthmatic  paroxysm. 
The  nasal  mucous  membrane  is  continuous  with  the  lining 
membrane  of  the  pharynx,  Eustachian  tubes,  larynx,  trachea 
and  bronchial  tubes  and  concussion  is  equally  influential  for 
weal  in  acute  congestion  of  the  same  membrane  irrespective 
of  location.  Thus  many  acute  congestions  of  the  bronchial 
mucosa  may  be  aborted  by  concussion  of  the  yth  cervical 
spinous  process. 

COLD  EXTREMITIES. — This  frequent  condition  has  never, 
to  my  knowledge,  been  dignified  by  a  technical  name,  and 
the  author  proposes  the  term  acropsychrosthesia,  signifying 
a  feeling  of  cold  in  the  extremities. 

The  effects  of  cold  upon  the  skin  (dermatitis  congelationis} 
as  in  that  common  condition  known  as  chilblain  or  pernio 
are  really  caused  by  insufficiency  of  the  vaso-motor  apparatus 
and  the  writer  has  successfully  treated  this  obstinate  con- 
dition by  repeated  seances  of  concussion  of  the  spinous 
process  of  the  yth  cervical  spine.  During  treatment,  if  the 
parts  are  hyperemic,  one  may  note  definite  areas  of  anemia 
in  the  hands,  feet  or  face. 

Many  circulatory  disturbances  in  the  face,  notably  acne 
rosacea,  are  likewise  vaso-motor  neuroses  and  they  also  yield 
to  the  foregoing  method  of  treatment. 

ANGIOPARALYTIC  NEUROSES. — In  neurasthenia,  hysteria 
and  other  neuroses,  the  vaso-motor  symptoms  seem  to 

285 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

dominate  the  clinical  picture.  Here  the  patient  complains 
of  pulsations  throughout  the  body,  notably  the  head,  and 
the  face  is  observed  to  be  in  a  condition  of  hyperemia.  Neu- 
rasthenics have  a  symptom  in  common :  a  feeling  of  heavy 
weight  or  constriction  about  the  head.  Charcot  graphically 
described  the  head -sensation  as  the  "casque  neurasthenique" 
a  feeling  as  though  the  patient  were  wearing  a  tight -fitting 
helmet.  The  author  has  never  encountered  in  the  literature 
any  explanation  of  this  phenomenon,  and  he  is  constrained 
to  conclude  that  it  is  a  vaso-motor  symptom  considering  the 
beneficial  results  of  treatment  consecutive  to  the  employ- 
ment of  concussion  of  the  spinous  process  of  the  yth  cervical 
vertebra. 

Toxic  CONDITIONS. — During  the  change  of  life  or 
MENOPAUSE,  the  vaso-motor  disturbances  are  almost  as 
common  as  the  arrest  or  irregularity  of  the  menses.  Flushing, 
heat  and  perspiration  alternate  with  pallor  and  chills,  and 
these  symptoms  often  persist  despite  treatment  to  the  end 
of  life. 

DIGESTION-AUTOINTOXICATION. — The  author  employs 
this  term  to  signify  a  train  of  vaso-motor  symptoms  peculiar 
to  some  individuals  who,  after  the  ingestion  of  a  meal,  suffer 
from  fullness  and  pulsations  of  the  head,  followed  by  throb- 
bing in  the  arteries  throughout  the  body.  In  association 
with  these  signs,  the  patients  are  depressed  or  despondent 
and  are  disinclined  to  execute  their  routine  work.  These 
symptoms  are  regarded  as  neurasthenic,  but  they  are  really 
due  to  autointoxication.  Our  conception  of  the  latter 
affection  is  faulty,  insomuch  as  we  regard  its  causation  to  be 
associated  with  putrefaction  of  albuminoid  food  in  the 
intestines.  We  forget  that  there  are  also  poisonous  album- 
oses,  i.e.,  intermediate  products  manufactured  in  the 
digestion  of  albuminous  foodstuffs,  and  investigations  show 

286 


Vaso-Motor    Neuroses 

that  an  aqueous  extract  of  the  contents  of  the  small  intestine 
is  infinitely  more  toxic  than  an  extract  made  from  the 
contents  of  the  large  intestine. 

Patients  suffering  from  digestion -autointoxication  ex- 
perience relief  as  a  rule,  several  hours  after  a  repast. 

In  the  treatment  of  these  patients,  the  exclusion  of 
albuminoid  food  is  beneficial,  but  the  best  results  are  achieved 
if  the  vaso -motor  center,  which  bears  the  brunt  of  the  dis- 
turbance, is  made  resistant  to  the  action  of  the  poisons. 

Here,  treatment  by  concussion  of  the  yth  cervical  spine 
has  given  me  excellent  results. 


287 


S  p     o    n     d    y    I    o    the    r    a    p    y 
CHAPTER  VIII. 

THE  RESPIRATORY  APPARATUS. 

PHYSIOLOGY — HISTOLOGY — POSTURAL  LUNG-DULLNESS — LUNG  REFLEX 
OF  DILATATION — LUNG  REFLEX  OF  CONTRACTION — PULMONARY 
ATELECTASIS — BRONCHIAL  ASTHMA — SPASMODIC  BRONCHOSTEN- 
OSIS — TUBERCULOSIS — HEMOPTYSIS. 

PHYSIOLOGY. 

'"T^HE  object  of  respiration  is  to  exchange  gases  between 
•*-  the  tissues  and  the  external  air.  The  blood  circulating 
through  the  lungs  absorbs  oxygen  from  the  alveolar  air  and 
yields  its  gaseous  products  of  decomposition,  notably  carbon 
dioxid. 

There  are  two  phases  of  respiration: 

1.  Inspiration,  which  is  effected  by  elevation  of  the 
ribs  and  by  contraction  of  the  diaphragm. 

2.  Expiration,  which  is  a  passive  act  and  requires  no 
muscular  effort. 

In  man,  the  diaphragm  predominates  over  the  rib-lifting 
muscles,  and  the  reverse  is  the  case  in  women;  hence,  the 
normal  type  of  respiration  in  man  is  abdominal,  and  in 
women,  costal. 

When  this  type  of  respiration  is  reversed  (page  85),  it 
becomes  the  fundamental  condition  of  many  respiratory 
neuroses  and  accentuates  the  symptoms  of  organic  affections 
of  the  lungs. 

In  Fig.  77,  two  extreme  types  of  respiration  are  indicated : 
A,  the  diaphragmatic,  and  B,  the  thoracic  type.  In  A, 
there  is  no  thoracic  movement,  but  the  anterior  abdominal 
wall  during  inspiration  projects  to  i.  In  B,  on  the  contrary, 

288 


Respiratory     Mechanism 


the  thoracic  wall  moves  forward  and  upward,  whereas  the 
abdominal  wall  instead  of  projecting  is  really  drawn  in. 

The  RESPIRATORY  MECHANISM  (Fig.  78)  is  regulated  by 
the  respiratory  center  in  the  medulla  oblongata,  the  so- 
called  rioeud  vital  of  physiologists,  which  corresponds  in 
position  with  the  vagus-nuclei.  The  muscles  which  enlarge 
and  diminish  the  size  of  the  thoracic  cavity  are  innervated 


FIG.  77. — Diaphragmatic  breathing  in  a  male  and  the  thoracic  type  of  breathing 
in  a  female. 

by  nerves  derived  from  the  spinal  cord;  the  diaphragm  is 
supplied  by  the  3rd  and  4th  cervical  roots  and  the  phrenic 
nerve. 

The  motor  nerves  for  the  muscles  of  the  larynx  and 
bronchi  run  in  the  trunk  of  the  vagus. 

HISTOLOGY. 

It  is  now  known  that  longitudinal  as  well  as  circular 
muscular  fibers  exist  in  the  finer  bronchial  tubes  of  rabbits, 
and  Aufrecht  has  shown  that  a  powerful  layer  of  circular 
and  a  weaker  layer  of  longitudinal  fibers  exist  in  man- 

289 


S  p 


o    n 


d 


loth 


r    a   p    y 


These  bronchial  muscles  are  under  the  influence  of  the  vagi 
and  can  be  made  to  contract  and  relax  as  the  result  of 
stimulation  of  the  vagi.  Thus  we  have  bronchoconstrictor 
and  bronchodilator  fibers  in  the  vagus. 

The  chief  bronchoconstrictor  reflexes  are  elicited  from 
the  mucous  membrane  of  the  nose  and  larynx. 


Respiratory  Centre 

in 
Medulla 


FIG.  78. — Diagram  of  the  respiratory  center  (Butler). 

The  bronchial  musculature  is  further  discussed  on  page 
308. 

Recently,  the  presence  of  vaso-motor  nerves  in  the  lungs 
has  been  absolutely  denied. 

The   author  has  referred61   to   a  condition  known  as 

POSTURAL  LUNG-DULLNESS. 

Any  one,  however,  reasonably  skilled  in  percussion  will, 
when  attention  is  called  to  the  fact,  recognize  a  decided 
difference  in  the  percussion  note  of  the  lungs  if  percussion 

290 


Postural      Lung    -    Dullness 

is  made  first  in  the  erect  and  then  again  in  the  recumbent 
posture.  One  will  also  note  a  difference  if  the  patient  is 
percussed  first  leaning  far  forward  and  then  backward  (sup- 
ported by  an  assistant).  In  other  words  (the  author  is 
assuming  an  average  typical  normal  subject),  the  percussion 
changes  correspond  in  a  minor  degree  to  the  alterations  in 
the  percussion  note  when  fluid  is  present  in  a  pleural  space. 
The  changes  noted  would  be  as  follows : 

Leaning  far  forward:  Anterior  chest  region  diffused 
dullness,  especially  marked  in  a  definite  area.  Posterior 
chest  region  hyperresonant. 

Leaning  far  backward:  Posterior  chest  region  shows 
diffused  dullness,  notably  in  a  definite  area.  Anterior  chest 
wall  elicits  a  hyperresonant  percussiqn  note. 

Leaning  to  one  side:  Side  of  chest  wall  toward  which 
patient  inclines  shows  dullness,  whereas  the  other  side  is 
hyperresonant. 

Lying  on  one  side:  Side  of  chest  on  which  the  patient 
lies  demonstrates  dullness  of  the  lung,  including  the  apex, 
whereas  the  other  side  is  hyperresonant. 

Recumbent  posture:  The  anterior  thoracic  wall  is  decid- 
edly more  resonant  than  in  any  other  posture. 

Prone  posture:  The  posterior  thoracic  region  is  more 
resonant  than  in  any  other  posture. 

Exaggerated  Trendelenburg:  Slight  dullness  of  the 
pulmonary  apices ;  lower  chest  region  hyperresonant. 

Differential  Diagnosis:  Postural  dullness  as  a  patho- 
logical phenomenon  is  frequently  encountered  and  may  be 
confounded  with  the  dullness  of  atelectasis.  Dullness 
dependent  on  atelectasis  is  usually  circumscribed  and  may 
be  dispelled  by  a  series  of  forced  inspirations,  rubbing  the 
skin  over  the  area  of  dullness  to  provoke  the  lung  reflex  of 
dilatation  and  by  the  cocain  test  (page  297). 

291 


S  p     o     n     d    y    I    o     the     r    a    p    y 

Postural  dullness  is  usually  diffused,  involving  one  or 
more  lobes,  and  cannot  be  dispelled  by  forced  inspirations, 
the  cocain  test,  or  by  exciting  the  lung  reflex.  The  dullness 
in  question,  however,  disappears  at  once  by  a  complete 
change  in  the  posture  of  the  patient.  Assuming,  for  example, 
that  the  dullness  is  somewhere  over  the  posterior  surface  of 
the  chest,  its  dissipation  cannot  be  effected  until  the  patient 
assumes  the  prone  posture. 

Etiology  of  Postural  Dullness. — After  a  careful  consid- 
eration of  this  subject  the  author  is  constrained  to  conclude 
for  the  following  reasons  that  the  dullness  provoked  by 
posture  is  dependent  on  the  blood  normally  present  in  the 
blood-vessels  of  the  lungs,  which  is  influenced  by  gravity, 
like  any  other  fluid : 

i.  The  blood  in  the  lungs,  unlike  in  other  viscera,  is 
not  restricted  in  amount,  owing  to  the  absence  of  vaso-motor 
nerves.  2.  The  area  of  most  pronounced  dullness  (as 
influenced  by  posture)  corresponds  to  the  situation  of  the 
largest  pulmonary  vessels,  and  is  least  manifested  in  areas 
where  the  vessels  are  less  abundant.  3.  In  passive  conges- 
tion of  the  lungs  observed  in  cardiopaths,  the  dullness 
elicited  by  postural  changes  is  most  pronounced.  4.  The 
postural  dullness  is  uninfluenced  by  all  the  manceuvers  which 
act  upon  either  the  bronchoconstrictor  or  bronchodilator 
nerves  of  the  vagus. 

Postural  Lung  Dullness  in  Disease. — As  already  observed, 
postural  lung  dullness  is  observed  as  a  normal  condition, 
or  perhaps,  to  speak  more  definitely,  in  the  norm,  lung 
resonance  is  modified  by  posture.  In  passive  congestion  of 
the  lungs  it  is  most  pronounced.  In  pulmonary  tuberculosis 
I  have  noted  only  slight  impairment  of  lung  resonance  as 
determined  by  posture,  and  this  observation  applies  with 
equal  cogency  to  the  pretuberculous  lung.  For  this  reason 

292 


Postural      Lung    -    Dullness 

I  seek  to  augment  the  quantity  of  blood  in  the  apices  of  the 
lungs  by  having  my  tuberculous  patients  raise  the  foot  of 
the  bed  so  that  the  blood  will  gravitate  toward  the  apices. 
After  this  manner  I  endeavor  to  induce  a  passive  hyperemia 
of  the  regions  in  question.  I  cannot  speak  of  results,  inas- 
much as  this  innovation  has  not  been  subjected  to  the  test 
of  time.  Sir  James  Barr,  in  his  erudite  Bradshawe  lecture 
before  the  Royal  College  of  Physicians,  London,  refers  to 
the  frequency  of  atelectasis  in  exhausting  diseases,  which 
may  be  mistaken  for  a  pleural  effusion.  He  furthermore 
says :  "Atelectasis  is  often  mistaken  for  hypostatic  congestion 
of  the  lung,  and  forcible  rubbing  of  the  affected  side,  acting 
through  the  lung  reflex  of  Albert  Abrams,  causes  some 
expansion  of  the  lung  and  clears  up  the  percussion  note." 
My  observations  do  not  tally  with  the  latter.  On  the  con- 
trary, ever  since  I  recognized  the  method  of  differentiating 
lung  atelectasis  and  lung  hyperemia,  I  am  convinced  that 
what  is  frequently  regarded  as  atelectasis  is  in  reality  a 
passive  congestion. 

Postural  Dullness  in  Treatment. — The  empirical  treat- 
ment of  pulmonary  affections  by  external  applications  to 
the  thoracic  wall  is  fully  justified,  since  the  lung  reflex  of 
dilatation  has  been  recognized.  The  postural  treatment  of 
diseases  of  the  lungs  is  equally  justified  by  the  foregoing 
observations  of  the  author.  One  fact,  however,  must  be 
emphasized,  and  that  is,  the  posture  assumed  by  the  patient 
must  be  an  extreme  one.  Thus,  to  contend  against  hypo- 
static  congestion  the  patient  must  assume  the  prone  posture 
at  least  for  a  time  several  times  a  day.  In  hemoptysis,  the 
correct  posture  can  be  determined  when  the  area  involved 
in  the  bleeding  yields  a  resonant  percussion  note  and  in- 
dicates the  exsanguination  of  the  area  in  question. 


293 


Spondyloth     e     r    a   p    y 


THE  LUNG  REFLEX  OF  DILATATION. 

This  reflex  demonstrates  the  important  fact  that  the 
respiratory  area  may  be  influenced  indirectly  by  stimuli 
acting  on  the  vagi.  In  a  contribution  by  Moscucci,62  the 
suggestion  was  made  that  when  ether  was  sprayed  over  the 
left  half  of  the  abdomen,  marked  reduction  in  volume  of 
the  spleen  was  observed  in  twelve  cases.  In  repeating  the 
experiments,  I  likewise  noticed  a  decided  reduction  in  the 
area  of  splenic  dullness  in  all  individuals  on  whom  this 
method  was  tried,  irrespective  of  the  fact  whether  enlarge- 
ment of  the  spleen  existed  or  not.  Investigations  convinced 
me  that  this  diminution  in  the  area  of  splenic  dullness  was 
not  real,  but  only  apparent.  When  the  ether  spray  was 
directed  over  the  region  of  the  heart,  the  percussional  area 
of  that  organ  was  reduced  at  once;  in  fact,  the  superficial 
area  of  cardiac  dullness  could  be  obliterated  by  the  man- 
oeuver.  Similarly,  when  the  spray  was  directed  over  the 
hepatic  region  the  superficial  area  of  dullness  of  that  organ 
could  be  reduced  at  once.  When  the  spray  was  directed 
over  the  border  of  the  lungs  posteriorly,  the  lung  borders 
could  be  made  to  descend  from  two  to  four  inches,  dependent 
on  certain  conditions.  It  was  further  ascertained  that  dis- 
location of  the  lung-borders  by  forced  inspiration  never 
approached  the  dilatation  of  the  lungs  produced  by  the 
cutaneous  application  of  the  ether  spray.  Further  experi- 
ments demonstrated  in  brief  the  fact  that  the  application 
of  any  cutaneous  irritant,  whether  the  latter  be  mechanic, 
chemic  or  electric,  would  always  induce  acute  dilation  of  the 
lungs.  Even  in  emphysematous  individuals  the  application 
of  a  cutaneous  irritant  still  further  augmented  the  existing 
lung-dilation.  The  question  naturally  arose,  by  what  means 
could  we  establish  the  fact  that  the  application  of  any 

294 


L,  u  n  %    Re  f  I  ex    of    Dilatation 

cutaneous  irritant  would  cause  acute  dilation  of  the  lungs, 
a  condition  which,  it  may  be  mentioned  parenthetically,  is 
only  of  a  few  minutes  duration.  Such  a  hypothesis  was 
made  tenable  by  the  aid  of  conventional  physical  signs  and 
the  use  of  the  fluoroscope.  These  aids  show  that  when  the 
skin  is  irritated  by  means  of  cold,  by  friction,  or  by  a  strong 
Faradic  current,  lung  dilation  will  ensue.  The  degree  of 
lung  dilation  is  dependent  upon  the  character  of  the  irritant 
and  the  severity  of  its  application.  The  response  of  the  lung 
to  dilation  is  always  greatest  in  that  part  of  the  lung  con- 
tiguous to  the  source  of  cutaneous  irritation.  Lung  dilation 
may  be  recognized  by  the  following  physical  signs:  i. 
Diminished  respiratory  excursions  of  the  lung  borders. 
2.  Extension  of  the  pulmonary  percussion  note  and  oblit- 
eration of  the  cardiac  and  splenic  areas  of  dullness.  3. 
Hyperresonance  of  the  lungs.  4.  Obliteration  of  the  apex 
beat.  Auscultation  is  of  no  value  as  a  physical  sign,  inas- 
much as  the  artificial  dilation  does  not  last  longer  than 
three  minutes  after  the  source  of  cutaneous  irritation  has 
been  removed.  Lung  dilation  spreads  from  the  source  of 
cutaneous  irritation  involving  primarily  circumscribed  parts. 
In  lungs  showing  resonance,  the  latter  could  always  be  in- 
creased by  cutaneous  irritation  over  the  part  percussed. 
The  x-rays  show  how  the  brightness  of  the  lungs  is  increased 
by  cutaneous  irritation.  By  gradually  applying  the  irritant 
to  different  parts  of  the  skin  of  the  thorax,  one  may  note 
that  eventually  the  entire  lung  may  be  made  to  yield  a  more 
intense  luminosity.  This  increased  luminosity,  however,  does 
not  last  longer  than  three  minutes  in  the  average  person, 
after  which  time  the  lungs  resume  their  normal  appear- 
ance. 

In    a    number    of    measurements    made    during    the 
study  of  the  lung  reflex  after  cutaneous  irritation,  I  found 

295 


S    p     ondylotherapy 

the  average  dislocation  of  the  lower  border  of  the  lung,  as 
follows : 

Right  sternal  line 3^  cm. 

Right  parasternal  line 3^  cm. 

Right  mammillary  line 4  cm. 

Right  axillary  line 6  cm. 

In  another  communication,  I  demonstrated  that  acute 
dilation  of  the  lungs  can  be  evoked  in  healthy  persons  by 
irritation  of  the  nasal  mucosa  and  conversely,  that  this  con- 
dition can  be  dissipated  after  the  removal  of  the  source  of 
irritation.  The  pulmonary  neurosis  of  dilation  can  be 
obtained  by  firmly  compressing  cotton  in  both  nasal  cavities. 
The  degree  of  lung  dilation  with  its  concomitant  phenomena 
will  naturally  vary  according  to  circumstances  which  modify 
other  reflex  acts.  After  the  introduction  of  the  cotton,  a 
few  moments  elapse  before  percussional  results  are  noted. 
One  will  then  observe  superresonance  and  immobilization 
of  the  lung-borders  and  diminution  of  the  areas  of  hepatic 
and  cardiac  dullness,  in  the  latter  instance,  even  to  obliter- 
ation. Irritation  of  one  nasal  cavity  with  cotton  does  not 
yield  manifest  results.  If  the  mucosa  of  both  nasal  cavities 
has  been  thoroughly  cocainized  before  the  introduction  of 
the  cotton,  no  lung  dilation  ensues.  I  have  frequently  en- 
countered in  my  clientele,  individuals  presenting  the  sympto- 
matic picture  of  pulmonary  vesicular  emphysema  in  whom 
wa^  associated,  some  abnormity  of  the  nose.  The  anomaly 
was  a  simple  coryza,  spurs,  deflection  of  the  septum,  hyper- 
trophic  rhinitis  or  polypi.  At  any  rate,  after  eradication  of 
the  nasal  anomaly,  the  symptoms  of  pulmonary  dilation 
disappeared.  The  form  of  emphysema  here  cited  is  in 
reality  an  acute  lung  dilation,  an  eradicable  condition  dis- 
sociated with  the  anatomico -pathologic  conditions  conven- 
tionally allied  with  emphysema.  The  typic  clinical  picture 

296 


Lung    Reflex    of  Dilatation 

of  acute  lung  dilation  could  nearly  always  be  made  to  dis- 
appear by  the  aid  of  the  cocain  test,  which  constitutes  in 
this  form  of  pulmonary  neurosis  a  diagnostic  aid  of  unques- 
tioned value.  After  application  of  a  solution  of  cocain  to 
the  nasal  mucosa,  the  lung-borders  will  recede  and  the  lung 
resonance  and  normal  vesicular  respiration  are  restored. 
In  patients  suffering  from  asthma  of  presumable  nasal 
origin,  impaction  of  cotton  in  one  or  both  nasal  cavities 
may  induce  a  typic  asthmatic  paroxysm.  This  fact  is  of 
undoubted  diagnostic  value.  I  maintain  that  the  phenomena 
of  lung  dilation  can  be  provoked  at  any  point  in  the  extensive 
course  of  distribution  of  the  pneumogastric  nerves,  and  that 
the  stimuli  may  act  indirectly  on  the  vagi  through  the 
terminal  fibers  of  the  trigeminus  or,  by  irritation  of  the 
cutaneous  sensory  nerves  contiguous  to  the  lungs. 

It  is  necessary  to  hypothesize  the  existence  of  two 
distinct  functions  of  the  vagus  nerve,  or,  at  any  rate,  different 
fibers,  with  two  distinct  functions — fibers  which  can  dilate 
(bronchodilator  nerves)  and  fibers  which  contract  (broncho - 
constrictor  nerves)  the  lungs  upon  application  of  the  appro- 
priate stimuli.  In  the  action  of  these  two  sets  of  nerve 
fibers,  the  vasoconstrictor  and  vasodilator  nerves  of  the 
vaso-motor  system  may  be  cited  as  analogous. 

It  may  be  interesting  to  observe  that  the  author's  hypo- 
thesis concerning  the  existence  of  bronchodilator  and 
bronchoconstrictor  fibers  in  the  vagus  was  confirmed  seven 
years  later  by  the  well-known  physiologic  investigations  of 
Dixon  and  Brodie. 

Respecting  the  diagnostic  value  of  the  lung  reflex,  atten- 
tion has  already  been  directed  to  its  importance  in  percussion 
(page  204). 

In  England,  Auld  and  Sir  James  Barr,  and  in  Italy, 
Plessi,  direct  reference  to  the  reflex  in  the  differentiation  of 

297 


Spondylotherapy 

atelectasis  and  consolidation  of  the  lung;  in  atelectasis, 
irritation  of  the  skin  contiguous  to  the  affected  area  will 
convert  the  dullness  into  resonance,  whereas  if  the  dullness 
is  due  to  a  consolidation,  the  lung  reflex  will  not  influence 
the  dullness. 

In  x-ray  examinations  of  the  lungs,  an  area  of  opacity 
due  to  atelectasis  may  be  mistaken  for  consolidation;  the 
lung  reflex  would  immediately  clear  the  opacity  in  atelectasis 
but  would  not  influence  the  shadow  caused  by  a  consolidation. 

Cesare  Minerbi,  of  Ferrara,  Italy,  regards  the  absence 
of  the  lung  reflex  posteriorly  as  one  of  the  earliest  and  most 
trustworthy  signs  of  pulmonary  tuberculosis.  This  con- 
clusion was  based  on  a  study  of  300  cases  and  14  autopsies. 

THE  LUNG  REFLEX  OF  CONTRACTION. 

Cherchevsky  directed  attention  to  a  sign  of  early  arteri- 
osclerosis. He  found  that  in  the  norm,  the  diameter  of  the 
aorta  varies  at  different  times.  It  became  dilated  if  the 
region  of  the  chest  over  the  arch  of  the  aorta  is  struck  with 
the  percussion  hammer,  while  it  shrinks  in  size  if  the  blows 
are  struck  in  the  epigastrium.  In  arteriosclerosis  it  is 
impossible  to  produce  these  variations  in  diameter. 

Cherchevsky  has  misinterpreted  the  phenomenon  ob- 
tained by  his  manceuver.  What  he  really  elicits  is  a  cir- 
cumscribed lung-contraction  adjacent  to  the  part  struck  on 
the  chest  by  the  hammer  and  the  blow  on  the  epigastrium 
merely  causes  the  collapsed  lung-area  to  dilate  (lung  reflex 
of  dilatation),  thus  supplanting  dullness  by  resonance. 
Dullness  may  be  elicited  in  practically  any  chest-region  by 
using  a  plexor  and  plexi meter.  The  circumscribed  dullness 
thus  induced  lasts  but  a  few  seconds,  but  may  be  made  to 
disappear  at  once  by  striking  the  epigastrium. 

Observed  with  the  x-rays,  the  lung  reflex  of  contraction 

298 


Pulmonary     Atelectasis 

is  an  interesting  study.  After  the  blow  is  struck,  the  adjacent 
lung-area  becomes  gradually  dark,  showing  that  the  air  has 
been  expelled  from  the  lungs,  whereas  in  a  few  seconds  the 
lung-area  becomes  bright  again.  This  lung  reflex  of  con- 
traction cannot  be  obtained  if  the  nasal  mucosa  has  been 
previously  cocainized. 

This  reflex  may  be  elicited  from  the  nasal  mucosa  or  the 
vertebral  region  so  that  both  lungs  are  brought  simultan- 
eously into  a  condition  of  contraction  and  when  the  reflex 
is  thus  obtained,  it  proves  of  great  therapeutic  value  in  the 
treatment  of  asthma  (page  312). 

PULMONARY  ATELECTASIS. 

The  proponent  of  any  new  method  of  treatment,  may, 
in  his  enthusiasm,  permit  the  imagination  to  run  riot,  thus 
presenting  assumptions  which  can  neither  be  demonstrated 
nor  corroborated  by  experience. 

The  author  has  endeavored  to  avoid  the  Scylla  and  Char- 
ybdis  of  medical  theorists  and,  for  this  reason,  will  only 
discuss  certain  diseases  of  the  respiratory  apparatus  which 
experience  has  taught  him  can  be  successfully  combated  by 
methods  advocated  in  this  book. 

It  is  the  accumulation  of  our  experiences,  observes 
Mundy,  that  makes  our  empirical  knowledge,  at  last,  scien- 
tific fact. 

Pulmonary  atelectasis  or  lung-collapse,  refers  to  a  con- 
dition in  which  the  vesicles  of  an  entire  lung  or  only  lung- 
areas  are  collapsed  and  contain  little  or  no  air. 

We  may  here  disregard  the  many  causes  of  atelectasis 
and  confine  ourselves  to  the  discussion  of  two  frequent  causes : 
T.  Obstruction  somewhere  in  the  air-passages  (atelectasis 
of  obstruction) ;  2.  Defective  expansion  of  the  chest. 

ACUTE  BRONCHITIS  is  a  common  and  very  rarely  a  serious 

299 


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d 


I 


t    h 


r    a   p    y 


disease  in  healthy  adults.  In  young  and  old  subjects,  how- 
ever, there  is  always  danger  of  an  extension  of  the  catarrhal 
process  downwards  to  the  finer  tubes,  thus  conducing  to  an 
atelectasis  of  obstruction.  Such  atelectatic  areas  are  fre- 
quently the  site  of  broncho-pneumonic  patches  or,  as  it  is 
also  called,  capillary  bronchitis.  The  author  has  frequently 
observed  that  in  children  suffering  from  broncho-pneumonia, 
the  areas  of  dullness  are  not  wholly  due  to  the  broncho - 
pneumonic  condition,  but  to  adjacent  areas  of  atelectasis 
which  may  be  readily  be  dissipated  by  elicitation  of  the 
lung  reflex  (page  294). 


FIGS.  79  AND  80. — Atelectatic  zones  on  the  anterior  and  posterior  surfaces  of 

the  thorax. 


DEFECTIVE  EXPANSION  OF  THE  CHEST. — Any  loss  of 
inspiratory  power  may  induce  lung-collapse  independent  of 
any  other  factor.  Weak  and  rickety  children  with  their 
feeble  muscular  development  lack  this  inspiratory  power  and 
one  observes  this  enfeebled  power  in  old  age,  long  con- 
tinued fevers  and  in  individuals  who  are  bedridden. 

Even  in  the  norm,  certain  portions  of  the  lungs  are 
collapsed  and  deprived  of  sufficient  air  to  yield  a  dullness 
and,  in  some  instances,  flatness  on  percussion.  Not  infre- 
quently, the  apex  of  the  lung  in  its  entirety  may  be  atelectatic 
and  for  this  reason  alone,  some  individuals  have  been  pro- 

300 


Pulmonary      Anemia 

nounced  phthisical  by  physicians  who  fail  to  recognize 
atelectasis  of  the  lung.  These  areas  of  lung-collapse  or 
atelectatic  zones,  as  the  author  has  called  them,  usually  dis- 
appear after  a  series  of  deep  inspirations  or  upon  application 
of  the  lung  reflex  test  (page  298),  i.e.,  by  vigorous  rubbing 
of  the  skin  over  the  site  of  atelectatic  dullness. 

Not  infrequently,  reflex  irritation  of  the  bronchocon- 
strictor  fibers  in  the  vagus  by  some  anomaly  of  the  nasal 
mucosa  may  maintain  a  condition  of  atelectasis.  In  the 
latter  instance,  cocainization  of  the  nasal  mucosa  by  inhibit- 
ing the  action  of  the  constrictor  fibers  will  translate  the 
dullness  of  an  atelectatic  patch  into  resonance. 

In  the  accompanying  illustrations  (Figs.  79  and  80),  a 
composite  picture  is  projected  defining  the  usual  situation  of 
atelectatic  zones  based  on  an  examination  of  over  one 
hundred  apparently  healthy  individuals  (children  as  well 
as  adults). 

These  zones  are  frequently  mistaken  for  areas  of  lung- 
consolidation,  either  when  detected  by  percussion  or  seen  at 
an  x-ray  examination.  The  zones  bear  a  definite  relation 
to  the  points  of  election  and  paths  of  distribution  of  the 
lesions  in  chronic  pulmonary  tuberculosis  and  they  are 
frequently  present  in  what  the  author  has  called  "PULMONARY 

ANEMIA." 

The  latter  condition  is  more  frequent  in  children  than 
in  adults  and  fails  to  yield  to  ferruginous  preparations.  The 
syndrome  of  anemia,  however,  disappears  after  a  course  of 
methodic  respiratory  exercises.  Should  the  anemia  reappear, 
its  recrudescence  is  almost  invariably  associated  with  a 
reappearance  of  the  zones  of  atelectasis.* 


*For  a  more  extended  discussion  of  the  subject  of  pulmonary  anemia,  the  reader  is 
referred  to  the  author's  books,  Diseases  of  the  Heart,  page  46,  and  Diseases 
of  the  Lungs,  page  20. 

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Spondyloth     e     r    a    p    y 

TREATMENT  OF  PULMONARY  ATELECTASIS. 

Among  the  various  methods  for  expanding  the  lungs 
and  thus  opposing  the  condition  of  atelectasis,  the  following 
manoeuvers  are  suggested: 

1.  By  action  on  the  cutaneous  sensory  nerves. 

2.  By  forced  voluntary  breathing. 

3.  By  developing  the  muscles  of  respiration. 

4.  By  aid  of  posture. 

5.  By  vertebral  concussion. 

The  two  latter  methods  are  advocated  in  cases  of  emer- 
gency. 

I. — We  have  already  shown  that  the  lung  reflex  of 
dilatation  and  the  heart  reflex  of  contraction  may  be  evoked 
by  cutaneous  stimulation.  The  stimulation  of  the  respiratory 
center  is  greater  through  the  cutaneous  nerves  than  through 
the  branches  of  the  vagus  to  the  respiratory  organs.  In 
animals  which  have  been  made  apneic,  cutaneous  stimulation 
induced  strong  respiratory  movements.  We  must  therefore 
regard  cutaneous  stimulation  as  a  simple  and  powerful 
stimulant  of  the  centers  of  circulation  and  respiration. 

The  empirical  treatment  of  pulmonary  affections  by 
external  applications  (poultices,  friction  with  liniments  and 
hot  and  warm  compresses)  to  the  thoracic  wall  is  fully 
justified,  since  the  lung  reflex  of  dilatation  has  been  recog- 
nized. 

In  acute  pulmonary  affections,  and  in  infectious  diseases 
like  typhoid,  the  author  employs  carbonated  baths  and  the 
cutaneous  irritation  thus  induced  powerfully  influences 
cardiac  and  pulmonic  vigor.  In  these  affections  we  must  be 
prepared  to  dismiss  antipyresis  as  the  great  desideratum  in 
the  acute  infectious  diseases. 

II. — Forced  voluntary  breathing  may  be  achieved  by 

302 


B-ronchial      Asthma 

respiratory  exercises  and  for  rapid  lung-development,  the 
aid  of  the  pneumatic  cabinet  is  unquestionably  the  best 
method. 

III. — Feebly  developed  muscles  of  the  thorax  may  be 
strengthened  by  stimulation  of  the  respiratory  muscles 
peripherally  or,  better  still,  centrally  (to  secure  symmetrical 
development,  page  n),  by  aid  of  the  sinusoidal  current. 

IV. — Reference  has  been  made  to  postural  lung-dullness 
on  page  290.  Here  it  is  important  to  recall  the  necessity  of 
frequent  and  complete  changes  in  posture  to  obviate  the 
tendency  to  atelectasis  and  passive  congestion  of  the  lungs. 

V. — Concussion  of  the  spines  of  the  third  to  the  eighth 
dorsal  vertebrae  will  provoke  a  rapid  dilatation  of  both  lungs, 
thus  inducing  the  lung  reflex  of  dilatation  which,  however, 
is  of  short  duration  only;  hence  the  necessity  of  a  frequent 
repetition  of  the  manceuver. 

Other  rapid  methods  of  eliciting  the  latter  reflex  are: 

1 .  Stimulation  of  the  nasal  mucosa  by  irritating  vapors ; 
strong  vapors  like  those  of  ammonia  must  be  avoided  owing 
to  their  inhibiting  action  on  the  heart  (Fig.  56). 

2.  By  tapping  the  epigastrium  lightly.    Here,  forcible 
percussion  like  the  "Klopf-Versuch"  of  Goltz,  will  inhibit 
the  heart's  action. 

3.  By  placing  the  patient  in  a  warm  bath  and  directing 
cold  water  from  a  pitcher  to  strike  the  nape  of  the  neck  and 
flow  down  the  back. 

BRONCHIAL  ASTHMA. 

If  we  regard  this  affection  as  a  distinct  neurosis  of  the 
respiratory  apparatus,  it  may  be  defined  as  a  series  of 
paroxysmal  dyspneic  attacks  in  which  no  organic  disease 
can  be  recognized  in  its  causation.  Whatever  the  etiologic 
factor,  three  conditions  are  essential : 

303 


S   p    o     n    d    y    I    o     t    h     e    r    a    p.   y 

1.  Diminished  resistance  of  the  center  of  respiration. 

2.  Asthmogenic  points  somewhere. 

3.  Irritation  of  the  asthmogenic  points. 

The  asthmogenic  point  may  exist  anywhere  in  the  course 
of  the  distribution  of  the  vagus  nerve,  or  the  bronchocon- 
strictor  fibers  of  this  nerve  may  be  irritated  reflexly. 

The  usual  sources  of  irritation  are: 

1.  The  nose.    Here  a  probe  may  detect  some  sensitive 
spot   (asthmogenic  point)  and  irritation  of  this  spot  may 
induce  a  typic  asthmatic  paroxysm  or  symptoms  approaching 
it  like  dyspnea  or  a  feeling  of  constriction  about  the  chest. 
In  these  cases  of  asthma  of  nasal  genesis,  if  the  nose  is 
firmly  packed  with  cotton   (considering  the  fact  that    no 
asthmogenic  point  can  be  detected),  an  asthmatic  attack 
may  be  elicited.    A  spray  of  cocain  introduced  into  the  nose 
may  inhibit  a  paroxysm  of  asthma  if  it  is  of  nasal  origin. 
It  is  better  in  such  cases  to  cocainize  first  one,  and  then  the 
other  nostril  to  determine  which  side  of  the  nose  is  respon- 
sible for  the  irritation.    By  so  doing,  the  side  on  which  the 
nasal  anomaly  is  present  may  be  corrected  and  thus  cure  of 
the  asthma  may  be  effected. 

2.  The  asthmogenic  point  may  be  located  in  the  larynx 
(pharyngo-laryngeal  asthma).     Here,  likewise,  the  probe 
may  be  used  for  diagnostic  purposes. 

3.  The  point  of  irritation  may  be  intrabronchial  de- 
pendent on  bronchial  catarrh  and  one  observes  in  the  inter- 
paroxysmal  period  all  the  symptoms  of  bronchitis.     It  is 
difficult,  however,  to  determine  during  an  asthmatic  par- 
oxysm which  of  the  rdles  heard  during  auscultation  are  due 
to  bronchitis  and  which  to  bronchial  spasm.    This  question 
is  determined  by  the  author  by  having  the  patient  inhale 
nitrite  of  amyl  and  carrying  it  to  its  full  physiologic  effects ; 

304 


Bronchial       A    s    t    h 


m    a 


the  rales  due  to  spasm  will  disappear  temporarily,  whereas 
the  rdles  of  bronchitis  will  persist. 

4.  The  source  of  irritation  may  be  the  stomach  (dys- 
peptic asthma)  caused  by  indigestion.  Here  an  emetic  or 
vomiting  may  inhibit  an  attack.*  Intestinal  worms  rriay 
also  cause  asthma  (asthma  verminosum). 

Among  other  causes  of  asthma  may  be  briefly  mentioned 
the  sexual  apparatus  in  men  and  women,  the  kidneys  (renal 
asthma),  the  heart  (page  212),  malaria,  hysteria,  neuras- 
thenia, etc. 

Suggestion,  as  a  factor,  often  casts  discredit  on  the 
etiology  of  asthma  just  the  same  as  it  does  on  any  other 
neurosis.  The  operations  of'  the  gynecologist  and  rhinolo- 
gist,  and  the  treatment  of  the  neurologist  act  in  many 
instances  by  the  mere  suggestion  which  is  thrown  out  by 
the  therapeutic  manceuvers. 

If  asthma  can  be  produced  by  suggestion,  the  same 
factor  can  cure  it.  Thus  odors,  particularly  of  flowers,  may 
bring  on  an  asthmatic  paroxysm,  and  one  physician  induced 
an  attack  by  allowing  the  patient  to  smell  an  artificial  rose. 

Of  late,  exposure  of  the  chest  to  the  action  of  the  x-rays 
in  asthma  has  been  followed  by  cure,  and  here  again,  sug- 
gestion cannot  be  excluded.  Thus  I  recall  a  patient  who 
was  brought  to  my  office  for  an  examination  of  the  chest. 
She  had  asthma  and  the  x-rays  were  used  for  a  diagnostic 
object,  yet  her  physician  whom  I  saw  several  months  later 
assured  me  that  the  patient  was  cured.  She  was  under  the 
impression  that  the  rays  were  used  for  a  therapeutic  object 
and  a  single  exposure  sufficed  to  cure  her. 

There  are  numerous  conditions,  the  number  of  which  is 
rapidly  multiplying,  which  are  operative  in  etiology,  and 

*Vide  page  320,  concerning  the  etiology  of  asthma  from  odors. 

305 


Spondyloth     e     r    a   p    y 

which,  when  corrected,  lead  to  the  cure  of  asthma.  To 
relegate  asthma  to  the  category  of  the  neuroses  is  a  simple 
task,  but  to  do  so  will  deprive  many  sufferers  from  ultimate 
recovery.  The  trend  of  modern  medicine  is  to  deny  the 
existence  of  functional  diseases  as  mere  entities,  but  to 
endow  them  with  distinguishing  attributes. 

THEORIES  OF  CAUSE. 

1.  Spasm  of  the  bronchial  muscles. 

2.  Paralysis  of  the  bronchial  muscles  leading  to  loss  of 
expiratory  power  (Walshe). 

3.  A  bulbar  neurosis  consisting  of  an  excessive  reflex 
irritability  of  the  center  of  respiration  (See). 

4.  A  spasm  of  the  diaphragm  (Wintrich). 

5.  A  spasm  of  the  inspiratory  muscles  (Budd). 

6.  A    microbic    inflammation    of    the    bronchial    tree 
(Berkart). 

7.  Hyperemia  of  the  bronchial  mucosa  analogous   to 
urticaria  (Clark). 

8.  The  asthma -crystals  found  in  the  sputum  of  asth- 
matics irritate  the  peripheral  ends  of  the  fibers  of  the  vagus 
and    induce   reflex   spasm   of   the    bronchial   musculature 
(Leyden). 

9.  Swelling  of  the  bronchial  mucosa  as  demonstrated  by 
tracheoscopic  examination  (Stoerk). 

10.  An  exudative  bronchiolitis  which  induces  expiratory 
dyspnea  (Curschmann). 

11.  Epilepsy  of  the  lungs  (Trousseau). 

Among  the  more  recent  theorists,  Kingscote  contends 
that  a  dilated  ventricle  (right)  of  the  heart  predisposes  to 
and  maintains  a  condition  of  chronic  asthma.  He  assumes 
that  a  paroxysm  occurring  at  night  is  associated  with  the 
recumbent  posture;  the  dilated  heart  striking  the  vagi 

306 


Bronchial       A    s    t    h 


m    a 


which  lie  immediately  behind  the  heart  on  the. bony  spine. 

The  theory  of  Haig  assumes  that  the  uric  acid  in  the 
blood  irritates  the  vagi. 

The  x-rays,  in  the  opinion  of  the  author,  who  has  exam- 
ined many  asthmatics  during  a  paroxysm,  show  the  in- 
correctness of  several  theories.  Thus,  while  the  diaphragm 
is  retarded  in  its  excursions,  it  is  not  sufficiently  immobile 
to  warrant  the  theory  of  diaphragmatic  spasm. 

Again,  the  heart  does  not  approximate  the  spine  in  the 
recumbent  posture  to  the  extent  of  obliterating  the  triangular 
space  between  the  heart  and  the  spine;  hence  the  author 
cannot  accept  the  theory  of  Kingscote. 

A  study  of  the  pathologic  anatomy  of  bronchial  asthma 
reveals  the  pertinent  fact  that  nothing  is  suggested  con- 
cerning the  etiology  of  the  disease  and  even  the  pathologist 
in  consequence,  contends  that  it  is  a  reflex  neurosis. 

We  are  thus  constrained  to  determine  the  pathology  of 
the  disease  by  clinical  observations.* 

Based  on  clinical  observations,  the  author  assumes  the 
following  theory  concerning  asthma :  A  spasm  of  the  circular 
muscular  fibers  of  the  bronchi  with  inability  on  the  part  of  the 
weaker  (paralytic}  longitudinal  fibers  to  expel  the  residual 
air  imprisoned  by  the  spasm  of  the  circular  fibers. 

The  foregoing  mechanism  has  its  analogue  in  the  bladder 
musculature,  when,  in  consequence  of  a  spasm  of  the 
sphincter  vesicae,  the  weak  detrusor  vesic«  cannot  expel  the 
urine  and  ischuria  spastica  results.  The  spastic  retention 

*A.  G.  Auld  (The  Lancet,  Oct.  17,  1903),  in  commenting  on  "THE  LUNG  RE- 
FLEX OF  ABRAMS,"  observes,  "It  was  not,  however,  until  recent  years 
that  anything  like  a  satisfactory  demonstration  of  the  presence  of  broncho- 
dilator,  as  well  as  bronchoconstrictor  fibers  in  the  vagus  was  made  by  Roy 
and  Brown,  and  during  the  present  year  this  seems  to  have  been  conclusively 
established  by  the  work  of  Dixon  and  Brodie.  But  it  undoubtedly  stands  to 
the  credit  of  Abrams  to  have  proved,  at  least,  seven  years  since,  by  a  simple 
clinical  observation  that  the  vagus  must  contain  bronchodilator  as  well  as 
bronchoconstrictor  fibers." 

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a    p    y 


of  air  in  the  lungs  during  an  asthmatic  paroxysm  is  schemati- 
cally represented  in  Fig.  81. 

In  support  of  the  author's  spasmo- paralytic  hypothesis 
of  asthma,  the  following  evidence  is  presented : 

1.  Histologic  and  physiologic  facts. 

2.  Clinical  facts:     A.     The  picture  of  the  asthmatic 
paroxysm;    B.    Results  achieved  by  treatment. 


FIG.  81. — A,  the  normal  appearance  of  the  terminal  branch  of  a  bronchial 
tube;  B,  in  consequence  of  a  spasm  of  the  circular  fibers  the  bronchial  tube  is 
partially  occluded  and,  insomuch  as  this  occlusion  cannot  be  combated  by  the 
enfeebled  longitudinal  fibers  (which  can,  in  the  norm,  open  the  bronchial  tubes 
when  the  latter  are  contracted)  the  retention  of  air  causes  a  dilatation  of  the  lung- 
structures  peripheral  to  the  site  of  occlusion. 

Aufrecht63  has  shown  that  the  musculature  of  the  finer 
bronchi  consists  of  a  stout  layer  of  circular  and  a  weaker 
layer  of  longitudinal  fibers.  The  clinical  observations  of 
the  author,  which  were  subsequently  confirmed  by  the 
physiologic  investigations  of  Dixon  and  Brodie,  demonstrate 
that  the  vagus  contains  fibers  which  can  either  dilate  or 
constrict  the  bronchi.  The  lung  reflex  of  dilatation  (page 
294)  demonstrates  the  predominant  action  of  the  circular 
fibers  of  the  bronchial  musculature,  whereas  the  counter- 

308 


Bronchial       A    s    t    h 


m    a 


reflex  of  lung-contraction  (page  298),  shows  the  predominant 
action  of  the  longitudinal  fibers. 

In  asthmatics,  the  lung  reflex  of  contraction  is  obtained 
with  difficulty  owing  to  enfeeblement  of  the  longitudinal 
fibers,  hence  any  therapeutic  manoeuver  which  will  accen- 
tuate this  reflex  will  arrest  asthmatic  paroxysms  and  will 
prevent  their  recurrence.  This  is  the  basis  of  the  author's 
method  of  treatment  in  bronchial  asthma. 

In  the  norm,  the  lung  reflex  of  contraction  may  be  elicited 
in  the  following  ways : 

1.  By  forcible  concussion  over  any  area  of  the  lungs  by 
means  of  a  plexor  and  pleximeter.     This  manoeuver  will 
only  elicit  a  circumscribed  lung  reflex  of  contraction  (page 
298). 

2.  By  inhalation  of  amyl  nitrite  after  previous  cocainiza- 
tion  of  the  nose.     Here  the  lung  reflex  of  contraction,  as 
evidenced  by  dullness  of  the  lungs  on  percussion,  is  most 
conspicuous  in  the  infraclavicular  regions.    It  will  be  noted 
that  amyl  nitrite  inhalations  are  currently  employed  to  arrest 
an  asthmatic  paroxysm,  but  its  effects  are  usually  transitory. 
The  reason  for  this  is  evident.     Any  irritant  to  the  nasal 
mucosa  will  provoke  the  lung  reflex  of  dilatation,  but  if  the 
nasal  mucosa  is  previously  cocainized,   amyl  nitrite,   like 
many   other   drugs,    will   reflexly   stimulate    the    broncho- 
constrictor  nerves  and  by  inducing  the  lung  reflex  of  con- 
traction will  arrest  an  asthmatic  paroxysm. 

3.  There    are    several   preparations   used    in   a   nasal 
atomizer  which  are  efficacious  in  arresting  an  asthmatic 
paroxysm  but  which  are  not  curative.     One  is  a  secret 
preparation  known  as  the  Nathan  Tucker  remedy. 

Coincident  with  the  relief  attending  its  use,  the  hyper- 
resonant  lungs  become  dull  on  percussion  and  the  dullness 
is  always  in  proportion  to  the  relief  obtained.  In  other 

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S    p     o     n     d    y     I    o     t    h     e     r    a   p    y 

words,  this  preparation  by  provoking  reflexly  from  the  nose 
the  lung  reflex  of  contraction  brings  relief  to  the  asthmatic. 
From  various  analyses  made  of  the  Tucker  remedy,  some 
claim  that  no  cocain  is  present,  but  according  to  the  obser- 
vations of  the  author,  it  is  impossible  to  obtain  any  decided 
effects  without  its  presence.  The  author  suggests  the  fol- 
lowing as  a  cheaper  substitute  for  the  Tucker  remedy: 

Cocain 3  per  cent. 

Atropin  sulphate gr.  ii. 

Natrii  nitrosi gr.  ix. 

Glycerin gr.  xxx. 

Aquae  destil oz.  ss. 

M.S. — Atomize  for  two  minutes  in  each  nostril  and 
inspire  deeply. 

It  may  be  necessary  to  reduce  the  percentage  of  atropin 
insomuch  as  in  several  instances  mild  atropin  intoxication 
has  followed  the  use  of  the  spray. 

4.  By  concussion  of  the  spines  of  the  4th  and  5th  cer- 
vical vertebrae  and  by  sinusoidalization  of  the  same  spines. 
This  will  be  discussed  under  the  treatment  of  asthma. 

On  page  297  reference  was  made  to  the  cotton  test  in 
asthma.  Here  reference  will  be  made  to  another  test  in 
support  of  the  spasmo -paralytic  theory  of  asthma.  By  con- 
cussing the  spines  of  the  dorsal  vertebras  (3rd  to  the  8th), 
one  may  provoke  a  decided  lung  reflex  of  dilatation  and  in 
one  predisposed  to  asthma,  an  attack  or  symptoms  of  an 
attack  (dyspnea,  constriction  about  the  chest)  may  be 
provoked.  If  now,  the  spines  of  the  4th  and  5th  cervical 
vertebrae  are  concussed,  the  attack,  or  the  symptoms,  may 
be  temporarily  inhibited.  In  the  first  manceuver  the  lung 
reflex  of  dilatation  brought  the  circular  muscular  fibers  into 
action  and  in  the  second  manceuver  the  action  of  the  circular 

310 


Bronchial       A    s    t    h 


m    a 


fibers  was  inhibited  by  contraction  of  the  longitudinal 
fibers. 

5.  By  the  tracheal  traction  test,65  During  the  time  the 
head  is  thrown  forcibly  backward,  the  normal  resonance 
obtained  by  percussion  over  the  manubrium,  the  anterior 
chest  and  the  lower  lobes  of  the  lungs  posteriorly,  becomes 
translated  into  a  dull  or  flat  sound.  This  manceuver  is 
called  the  tracheal  traction  test  by  the  author  and  is  similar 
to  another  vago -visceral  reflex  described  elsewhere  (page 
321).  This  test  is  positive  in  health  and  in  all  cardio- 
pulmonary  affections,  but  it  is  negative  in  all  cases  of  idio- 
pathic  asthma.  This  test  is  present  in  the  interparoxysmal 
asthmatic  periods  of  asthma,  and  is  thus  of  value  in  the 
differential  diagnosis  of  other  spasmodic  affections  which 
suggest  an  asthmatic  genesis.  Tracheal  traction  evokes 
contraction  of  the  bronchial  muscle  by  stimulation  of  the 
bronchoconstrictor  nerves  in  the  vagus.  In  asthma  the 
tone  of  the  bronchial  muscle  is  so  reduced  that  it  no  longer 
responds  to  vagus  stimulation  when  the  neck  is  forcibly 
extended  on  the  sternum;  hence  the  test  is  negative  in 
asthma.  The  dull  sound  supplanting  the  resonance  in  the 
normal  subject  by  tracheal  traction  is  due  to  contraction  of 
the  bronchial  muscle,  which  puts  the  air  in  the  trachea  and 
bronchi  under  considerable  tension. 

There  is  another  affection  closely  related  to  asthma 
which  the  author  has  called  SPASMODIC  BRONCHOSTENOSIS, 
and  in  which,  like  asthma,  the  tracheal  traction  test  is  nega- 
tive. Patients  with  bronchospasm  suffer  from  a  persistent 
spasmodic  cough,  with  or  without  expectoration,  in  other 
words,  spasmodic  bronchostenosis  is  asthma  without  par- 
oxysms. 

Many  physicians  have  encountered  persistent  spasmodic 
coughs  in  subjects  with  bronchitis  and  have  no  doubt  com- 

311 


S   p     ondyloth     e     r    a    p    y 

mented  on  the  intractability  of  the  cases.  In  such  instances, 
a  bronchospasm  complicates  the  disease.  Here  climate 
yields  immediate  results.  The  patients  often  lose  their 
spasmodic  cough  at  once  if  sent  to  another  climate.  Here 
the  spray  described  on  page  310  is  very  efficient  in  con- 
trolling the  spasmodic  cough,  and  the  same  may  be  said  of 
the  smoke  from  various  antispasmodic  agents.  The  following 
formula,  which  owes  its  efficacy  to  pyridin,  may  be  used : 

Powdered  stramonium 

Powdered  belladonna 

Powdered  hyoscyamus 

Powdered  potassium  nitrate aa  i  oz. 

M.S. — Burn  one-half  teaspoonful  or  more  and  inhale 
fumes. 

6.  The  picture  of  an  asthmatic  paroxysm  suggests  the 
spasmo-paralytic  theory.  The  lungs  are  in  an  acute  em- 
physematous  condition,  and  the  dyspnea  is  expiratory  in 
character.  The  moment  the  spasm  is  relaxed  by  appropriate 
treatment,  the  lung  reflex  of  contraction  is  provoked. 

The  table  on  page  212  gives  the  differential  diagnosis  of 
cardiac  and  bronchial  asthma. 

TREATMENT  OF  BRONCHIAL  ASTHMA. 

An  attack  of  asthma  may  be  jugulated  by  any  manoeuver 
which  will  promote  the  expiratory  phase  of  respiration  or 
which  will  induce  the  lung  reflex  of  contraction.  The  author 
recalls  a  patient  seen  in  consultation,  whose  asthmatic 
paroxysm  was  of  two  days'  duration  despite  complete 
anesthetization  with  chloroform  and  recourse  to  the  con- 
ventional methods  yet,  a  few  minutes  rhythmical  compression 
of  the  chest  during  expiration  sufficed  to  control  the  attack. 
This  simple  method  has  been  used  with  success  in  other  cases. 

As  before  remarked,  the  lung  reflex  of  contraction  can 

312 


Bronchial      Asthma 

be  provoked  by  concussion  of  the  spines  of  the  4th  and  5th 
cervical  vertebrae  and,  in  the  absence  of  a  hammer  and 
pleximeter,  the  hands  may  be  used  (Fig.  3).  The  latter  ma- 
nceuver  often  succeeds  in  arresting  a  paroxysm,  but  it  may 
be  necessary  to  repeat  it  several  times.  In  the  treatment 
of  asthma,  one  frequently  observes  astonishing  cures  reported 
by  the  rhinologist  and  other  specialists.  Here  the  source 
of  irritation  (asthmogenic  point)  is  removed,  but  the  en- 
feebled condition  of  the  bronchial  musculature  is  unconnected 
and  any  other  irritant  may  be  operative  in  provoking  an 
attack. 

In  the  following  method  of  treatment  suggested  by  the 
author,  an  attempt  is  made  to  increase  the  vigor  of  the  longi- 
tudinal fibers  of  the  bronchial  musculature  with  the  object 
of  inducing  the  lung  reflex  of  contraction.  This  is  best 
effected  by  a  strong  sinusoidal  current — one  electrode  over 
the  spines  of  the  4th  and  5th  cervical  vertebrae  and  the  other 
electrode  over  the  sacrum.  The  treatment  must  be  executed 
daily  and  each  seance  may  last  from  fifteen  minutes  to  one 
hour.  Very  often  an  interrupting  electrode  at  the  cervical 
region  may  be  advantageously  employed  with  the  object  of 
exciting  more  vigorously  the  bronchoconstrictor  fibers  of  the 
vagus.  All  sinusoidal  machines  are  not  equally  efficient, 
and  to  test  the  latter  one  electrode  is  placed  over  the  spines 
of  the  4th  and  5th  cervical  vertebrae  in  a  normal  subject 
and  the  other  electrode  over  the  sacrum.  If  the  former 
lung-resonance  is  converted  into  dullness,  after  a  few  minutes 
action  of  the  current,  the  latter  is  efficient,  and  its  efficiency 
is  always  in  proportion  to  the  degree  of  lung-contraction 
which  it  provokes.  This  method  of  treatment  will  often 
yield  phenomenal  results  even  in  cases  of  asthma  of  many 
years'  duration. 

Until  the  bronchial  musculature  is  strengthened,  the 

313 


S   p 


o     n 


d    y    I 


t    h 


r    a   p    y 


attacks  of  asthma  will  continue  (with  less  violence)  and  to 
combat  the  attacks,  the  nasal  spray  (page  310)  may  be 
used. 

Adrenalin  chlorid  is  one  of  the  most  efficient  agents  in 
inhibiting  an  attack  of  asthma,  and  the  author  employs  it 
in  doses  of  from  eight  to  fifteen  minims  hypodermatically. 
The  action  of  this  drug  is  to  provoke  the  lung  reflex  of 
contraction  and,  when  effective  in  asthma,  the  previously 


FIG.  82. — Arrangement  of  bottles  for  promoting  lung-contraction. 

resonant  percussion  tone  of  the  lungs  is  converted  into  a 
dull  or  flat  sound.  Like  action  on  the  percussion  sound  is 
observed  in  the  normal  subject. 

In  addition  to  sinusoidalization  as  suggested,  the  patient 
should  be  instructed  to  execute  respiratory  exercises  at  least 
twice  daily  with  the  object  of  increasing  the  expiratory  force. 
The  latter  is  best  attained  by  extinguishing  with  the  breath 
the  flame  of  a  candle;  the  distance  of  the  latter  from  the 
patient  is  gradually  increased.  At  first,  the  effort  of  blowing 
may  provoke  asthmatic  symptoms,  but  gradually  the  latter 
yield.  The  latter  method  may  even  be  employed  in  arresting 
an  asthmatic  paroxysm. 

314 


He       m        op        t       y       s       i       s 

Another  efficient  method  of  promoting  the  muscles  of 
expiration  is  to  instruct  the  patient  to  practice  daily  for  a 
definite  time,  to  blow  water  by  air-pressure  from  one  bottle 
to  another.  Each  bottle  should  hold,  at  least,  a  gallon,  and 
by  the  arrangement  of  tubes,  as  in  the  Wolff  bottle,  the  force 
of  expiration  will  transfer  the  water  from  one  bottle  to 
another  (Fig.  82).  Osier  and  others  claim  that  the  method 
just  cited  will  expand  the  lungs,  but  the  author  has  shown 
that  the  effect  is  to  contract  the  lungs. 

EMPHYSEMA  is  an  affection  associated  with  enfeeblement 
of  the  longitudinal  fibers  of  the  bronchial  musculature. 
Here  sinusoidalization  as  suggested  in  the  treatment  of 
asthma  (page  313)  is  often  very  efficient  in  the  treatment  of 
emphysema  provided,  one  can  elicit  the  lung  reflex  of  con- 
traction (dullness  of  the  lungs  on  percussion)  even  in  a 
moderate  degree. 

TUBERCULOSIS  is  associated  with  a  too  voluminous  lung 
and  the  lungs  are  practically  in  an  emphysematous  condition. 
The  lungs  always  show  deficient  expiratory  force.  Here 
the  bronchial  musculature  may  be  brought  to  contraction 
by  sinusoidalization  as  in  the  treatment  of  asthma  (page  313). 

HEMOPTYSIS  may  yield  to  posture  (page  293)  and  the 
inhalation  of  amyl  nitrite  carried  to  its  physiologic  effects 
after  cocainization  of  the  nose.  This  is  the  most  efficient 
drug  we  possess  in  arresting  hemorrhage  of  the  lungs. 
Unless  it  is  efficient  after  the  first  inhalation,  it  is  usually 
without  any  action.  The  blood-vessels  of  the  lungs  have 
no  vaso -motor  nerves  and  any  constriction  of  the  blood- 
vessels must  be  effected  by  provoking  the  lung  reflex  of 
contraction.  Cocainizing  the  nose  increases  the  efficacy  of 
the  inhalations.  Whereas,  amyl  nitrite  may  effect  its  object 
without  the  previous  use  of  cocain,  the  latter  drug  increases 
its  efficacy  for  the  reason  cited  on  page  309. 

315 


S   p    o     n    d    y    I    o     i    h     e    r    a    p    y 


CHAPTER  IX. 

THE  DIGESTIVE  SYSTEM. 

THE  STOMACH — THE  STOMACH  REFLEXES — PERCUSSION  OF  THE 
STOMACH — TREATMENT  OF  DISEASES  OF  THE  STOMACH — THE 
INTESTINES — THE  INTESTINAL  REFLEXES — DISEASES  OF  THE 
INTESTINES — TREATMENT  OF  CONSTIPATION — THE  INTESTINAL 
NEUROSES. 

THE  STOMACH. 

By  means  of  the  movements  of  the  stomach  the  food  is 
mixed  with  the  gastric  juice.  The  motor  nerves  of  the 
stomach  are  derived  from  the  vagus  and  sympathetic  nerves. 
Fig.  83,  after  Openchowski,  shows  the  nerves  of  the  mus- 
culature of  the  stomach. 

THE  STOMACH  REFLEX  OF  CONTRACTION." 

This  consists  of  a  contraction  of  the  walls  of  the  stomach 
elicited  by  the  following  manceuvers: 

1.  Concussion  of  the  Traube.  area. 

2.  Concussion  or  sinusoidalization  of  the  spines  of  the 
three  first  lumbar  vertebrae. 

3.  By  eli citation  of  the  vago- visceral  reflex. 

4.  By  pressure  in  definite  paravertebral  areas. 

I.  The  Traube  area  or  space  (Fig.  84)  is  that  half- 
moon-shaped  space  which  normally  yields  on  percussion  a 
tympanitic  sound,  owing  to  the  presence  of  the  cardiac  end 
of  the  stomach.  It  is  bounded  above  and  laterally  by  the 
contiguous  borders  of  the  liver,  lung  and  spleen.  Fixing 
our  pleximeter  firmly  in  the  center  of  the  Traube  area  of 
tympanicity,  we  strike  the  pleximeter  with  a  hammer  a 
series  of  vigorous  blows,  and  then  proceed  to  percuss  the 

316 


Stomach     Reflex    of    Contraction 


area  of  Traube.     One  observes  at  once  that  this  region 
which  formerly  yielded  a  tympanitic  sound  now  presents  on 


FlG.  83. — Nerves  of  the  stomach  musculature.  C,  the  cerebrum;  V,  stomach; 
MO,  medulla;  MS,  spinal  cord;  5-10,  thoracic  roots;  VRS,  right  vagus;  VS, 
left  vagus;  ND,  dilators  of  the  cardia;  NC,  constrictors  of  the  cardia;  A, 
Auerbach's  plexus;  S,  S,  fibers  from  the  sympathetic  plexus;  i,  sulcus  cruri 
atus;  2,  corpus  striatum;  3,  corpus  quadrigemina;  4,  centers  in  the  spinal 
cord.  The  dilator  center  for  the  cardia  inhibits  the  movements  of  the  pylorus. 

percussion  a  dull  or  even  flat  sound.    The  phenomenon  thus 
elicited  is  the  stomach  reflex  of  contraction. 

II.  Concussion  of  the  spines  of  the  ist,  2nd  and  3rd 
lumbar  vertebrae  will  also  produce  the  stomach  reflex  of 
contraction. 

III.  Vide  percussion  of  the  stomach,  page  321. 

317 


S  p    o 


n 


t    h 


r    a    p    y 


IV.  Firm  and  deep  pressure  with  the  thumb  alongside 
of  the  spines  of  the  first  three  lumbar  vertebrae  on  the  left 
side  will  also  elicit  the  reflex  in  question. 

THE  STOMACH  REFLEX  OF  DILATATION. 

This  reflex,  consists  of  a  dilatation  of  the  stomach  pro- 
voked by  irritation  of  the  skin  over  the  area  of  Traube, 


FIG.  84. — Normal  percussion-boundaries  of  the  lungs,  liver  and  spleen,  and 
Traube's  space — anterior  view  (Sahli). 

after  tapping  the  epigastrium,  by  deep  and  firm  pressure 
to  the  left  of  the  spine  of  the  nth  dorsal  vertebra  and  by 
concussion  or  sinusoidalization  of  the  latter  spinous  process 
(Fig  85). 

Both  stomach  reflexes  may  be  confirmed  by  the  vago- 
visceral  reflex  which  is  described  under  percussion  of  the 
stomach. 

318 


Stomach     Reflex     of    Dilatation 


FlG.  85 — Effects  of  the  inhalation  of  ether  on  the  stomach :  continuous  line 
(A),  the  lower  border  of  the  stomach  before  and  (C),  after  the  inhalation  of  ether. 
Also  illustrating  area  of  gastric  tenderness.  If  a  point  of  tenderness  exists  at  xi, 
it  is  shifted  to  X2,  after  eliciting  the  stomach  reflex  of  contraction,  which  causes 
the  lower  border  of  the  organ  to  recede  from  A  to  B.* 


*Dilation  of  the  fundus  is  not  shown,  although  it  occurs.       This  illustration  is 
further  described  on  page  323. 

319 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

There  is,  perhaps,  no  greater  excitant  of  the  stomach 
reflex  of  dilatation  than  irritation  of  the  nasal  mucosa  by 
irritating  vapors.  The  effects  of  inhaling  ether  are  shown  in 
Fig.  85.  The  reflex  in  question  thus  excited  is  of  longer 
duration  than  any  other  visceral  reflex.  In  one  patient  the 
stomach  remained  dilated  for  fully  eight  hours.  Chloroform 
vapor  is  less  active  than  ether  in  provoking  the  reflex.  In 
this  reflex  the  fundus  of  the  stomach  likewise  dilates  and 
the  author  believes  that  the  asthma  from  odors  is  due  to 
pressure  of  an  acutely  dilated  stomach  on  the  heart.  Thus, 
one  patient  who  suffered  an  asthmatic  paroxysm  from  the 
odor  of  hay,  demonstrated  an  enormously  dilated  stomach. 
When  the  latter  was  reduced  by  concussion  of  the  spines 
of  the  first  three  lumbar  vertebrae,  the  paroxysm  ceased. 
When  the  nose  was  previously  cocainized,  no  asthma  could 
be  provoked  from  the  odor  of  hay.  The  effect  of  insufflation 
of  the  stomach  on  the  heart  is  shown  in  Fig.  33. 

In  the  literature,  a  number  of  cases  of  acute  dilatation  of 
the  stomach  have  been  reported  following  operations  which 
are  characterized  by  sudden  onset,  symptoms  of  collapse 
and  vomiting  of  large  quantities  of  fluid.  The  cause  is 
obscure,  but  the  author's  investigations  seem  to  show  that 
the  dilatation  is  associated  with  the  irritating  action  of  the 
vapors  employed  as  anesthetics.  Here  the  condition  is  a 
reflex  due  to  irritation  of  probable  gastro -dilator  fibers  in 
the  vagus.  As  the  author  has  shown  (page  202)  irritating 
vapors  will  inhibit  the  heart,  but  if  the  nose  has  been  pre- 
viously cocainized  such  action  does  not  ensue.  He  therefore 
suggests  the  use  of  cocain  in  the  nose  as  a  routine  method 
before  employing  anesthetics  to  inhibit  the  action  of  the 
vapors  on  the  heart  and  on  the  stomach.  Fig.  85  shows 
the  effects  of  inhalation  of  ether  (duration  of  inhalation,  one 
minute)  on  the  stomach. 

320 


Percussion     o  f    t  h  e     Stomach 

It  may  be  noted  that  concussion  of  the  spines  of  the  first 
three  lumbar  vertebrae  will  at  once  reduce  the  lower  border 
of  the  stomach  to  the  norm;  otherwise  the  dilatation  con- 
tinues for  some  time.  Such  concussion  may  be  of  service 
in  acute  dilatation  of  the  stomach  following  operations. 

PERCUSSION  OF  THE  STOMACH. 

No  gastrologist  can  lay  any  claim  to  distinction  in  his 
chosen  speciality  until  he  has  devised  some  original  method 
for  percussing  the  stomach,  and  the  result  has  been  a  number 
of  complicated  and,  in  some  instances,  faulty  methods  of 
examination.  The  author  contends  that  any  physician  who 
is  able  to  appreciate  percussion -sounds  can  accurately 
percuss  not  only  the  lower  border  of  the  stomach,  but  the 
upper  border  of  the  organ  as  well  (Fig.  86)  by  the  following 
simple  method  which  elicits  the  vago-visceral  reflex  of 
stomach-contraction. 

By  directing  the  patient  to  draw  the  head  slowly  back- 
ward, though  forcibly,  thus  inducing  hypertension  of  the 
cervical  muscles,  the  pneumogastric  nerves  are  stimulated 
and  this  stimulation  is  manifested  clinically: 

1.  By  inhibition  of  the  heart  (page  228). 

2.  By  the  tracheal  traction  test  (page  311). 

3.  By  the  stomach  reflex  of  contraction. 

To  obtain  the  latter  reflex,  the  borders  of  the  stomach 
are  percussed  during  the  time  the  patient  forcibly  extends 
his  head  as  far  back  as  possible.  When  he  is  unable  to  do  this 
satisfactorily,  an  assistant  may  do  it  for  him.  During  the 
time  tension  of  the  muscles  of  the  neck  is  maintained,  the 
stomach  yields  a  dullness  on  light  percussion  with  the  patient 
standing.* 

*The  dullness  is  accentuated  if  an  assistant  compresses  the  spinal  column  during 
percussion  (page  80). 

321 


Spondyloth 


r    a   p    y 


To  explain  the  altered  percussion  sound  in  the  stomach 
reflex  of  contraction,  one  must  have  recourse  to  the  Skodaic 
interpretation  of  the  condition  which  exists  when  dullness 
supplants  tympanicity.  In  the  stomach  reflex  of  contraction, 
the  gastric  walls  become  tense,  thus  putting  the  air  or  gas 
within  them  under  increased  tension,  and,  for  this  reason, 
we  have  the  physical  elements  necessary  for  the  transition 
of  a  tympanitic  to  a  dull  sound. 


FlG.  86.— Percussion  of  the  stomach  by  aid  of  the  vago-visceral  reflex  (the 
head  to  be  fixed  as  shown  in  Fig.  65).  The  illustration  with  the  dotted  line  indicates 
an  increased  area  of  the  organ  after  irritation  of  the  skin  of  Traube's  area.  The 
other  illustration  demonstrates  the  outline  of  the  stomach  in  a  case  of  gastroptosis. 

Reference  to  Fig.  5  shows  that  concussion  of  the  spines 
of  the  first  three  lumbar  vertebrae  is  not  available  for  per- 
cussion. While  the  latter  manoeuver  is  advantageous  in 
treatment,  it  also  provokes  the  intestinal  reflex  of  contraction 
and  as  the  latter  yields  a  dullness  on  percussion,  the  dullness 
of  this  reflex  cannot  be  differentiated  from  the  dullness  of 
the  stomach  reflex  of  contraction. 

THE    STOMACH    REFLEX    OF    CONTRACTION    IN    DIAGNOSIS. 

Reference  has  already  been  made  to  the  value  of  this 
reflex  in  percussion  of  the  stomach. 


322 


S   t   o    m    a    c    h   -  D  i  s  location 

It  remains  to  consider  its  value  in  determining  the  motor 
power  of  the  organ  and  the  localization  of  pain. 

Having  determined  the  lower  border  of  the  organ  by  aid 
of  the  vago -visceral  reflex,  we  concuss  rather  forcibly  tjie 
area  of  Traube  and  note  the  difference  of  the  lower  border 
before  and  after  such  concussion.  Naturally,  the  head  must 
be  maintained  properly  during  the  time  percussion  of  the 
stomach  is  executed.  It  will  be  noted  in  Fig.  85,  that  the 
lower  border  of  the  stomach  shifts  from  A  to  B,  which 
represents  the  degree  of  the  stomach  contraction  which  is  in 
direct  ratio  to  the  motor  power  of  the  organ.  In  the  norm 
the  degree  of  recession  of  the  lower  border  of  the  stomach 
varies  from  2  to  4  cm. 

Let  one  assume  that  the  patient  has  a  fixed  point  of 
sensitiveness  in  the  epigastrium  and  it  is  a  question  whether 
this  area  of  tenderness  is  or  is  not  associated  with  the  stomach. 
In  the  former  event,  concussion  of  the  area  of  Traube  by 
causing  contraction  of  the  stomach,  will  shift  the  area  of 
tenderness  from  Xi  to  X2  (Fig.  85).  Within  a  minute, 
however  (the  duration  of  the  reflex),  the  area  of  tenderness 
will  again  be  located  at  Xi*. 

The  presence  of  a  growth  and  its  association  with  the 
stomach  may  be  shown  to  exist  by  aid  of  the  stomach  reflex, 
for  elicitation  of  the  latter  will  cause  a  dislocation  of  the 
growth  upward  and  to  the  left.  Eliciting  the  stomach 
reflex  of  dilatation  (concussion  of  the  spine  of  the  nth 
dorsal  vertebra)  will  cause  an  area  of  tenderness  or  a  growth 
to  be  dislocated  downward. 

*The  author  suggests  this  manceuver  in  the  differential  diagnosis  of  a  gastric  and 
duodenal  ulcer.  The  employment  of  this  manceuver  will  not  cause  a  dis- 
location of  the  area  of  tenderness  on  palpation  if  the  ulcer  is  duodenal. 


323 


S    p     ondylotherapy 


TREATMENT. 

MOTOR-INSUFFICIENCY,  or  lack  of  power  of  the  muscular 
wall  of  the  stomach  to  discharge  its  contents,  results  from 
many  causes,  notably  the  burden  thrown  upon  it  by  in- 
discreet eating.  This  insufficiency  of  the  organ,  which 
practically  always  eventuates  in  dilatation  of  the  stomach 
(gastrectasis),  is  usually  regarded  as  a  dyspepsia,  insomuch 
as  the  symptoms  are  dyspeptic  in  character.  Many  so-called 
neuroses  of  the  stomach  are  dependent  on  the  same  cause. 
The  author  realizes  that  he  gives  expression  to  heterodoxic 
views  when  he  attempts  a  classification  of  all  diseases  of  the 
stomach  into  two  main  classes :  organic  and  functional.  To 
the  former  belong  chiefly  ulcers  and  tumors,  whereas,  the 
latter  are  not  diseases  but  merely  symptoms.  In  his  early 
professional  career,  the  author  religiously  executed  the 
conventional  gastric  analyses,  and  while  he  was  able  to 
determine  anomalies  in  the  gastric  secretion,  he  rarely 
succeeded  in  curing  his  patients;  he  was  successful  as  a 
diagnostician  and  a  failure  as  a  therapeutist.  The  moment 
he  departed  from  traditional  lines  and  sought  a  constitutional 
cause  for  the  symptomatic  affections  of  the  stomach,  he  began 
to  achieve  a  modicum  of  success  in  the  treatment  of  his 
cases. 

There  is  an  element  of  nervousness  in  all  dyspepsias, 
and  this  nervousness  is  maintained  by  an  enervated  nervous 
system.  In  all  instances  of  functional  diseases  of  the  stomach, 
treatment  must  be  addressed  to  an  enfeebled  nervous 
system ;  this  is  essentially  the  basis  of  gastrotherapy. 

In  the  experience  of  the  author,  the  most  constant  con- 
dition identified  with  functional  diseases  of  the  stomach  is 
an  insufficiency  of  the  muscular  walls  with  a  moderate 
dilatation  of  the  organ  and  the  relief  of  this  condition,  which 

324 


The         Intestine 

is  possible  after  the  manner  to  be  cited,  is  of  greater  value 
than  any  other  symptomatic  method  of  treatment. 

To  contract  the  stomach  and  to  augment  the  tone  of  its 
musculature  two  methods  are  available:  i.  By  aid  of  the 
sinusoidal  current;  one  electrode  over  the  space  of  Traube 
and  the  other  over  the  spines  of  the  first  three  lumbar 
vertebrae.  2.  By  concussion  of  the  spines  of  the  first  three 
lumbar  vertebrae.  Treatment  by  either  method  must  be 
executed  daily  and  each  seance  should,  at  least,  last  fifteen 
minutes. 

In  gastric  or  intestinal  TYMPANITES,  concussion  of  the 
spines  of  the  first  three  lumbar  vertebrae  to  elicit  the  stomach 
and  intestinal  reflexes  is  a  very  effective  method. 

THE  INTESTINE. 

The  movements  of  the  intestine  are  controlled  by  the 
central  nervous  system  and  the  small  intestine  receives  its 
efferent  nerves  through  the  vagus  and  the  splanchnic. 
Respecting  the  action  of  these  nerves  there  is  no  unanimity 
of  opinion.  It  may  be  remarked,  however,  that  vagus- 
stimulation  by  contraction  of  the  muscles  of  thi  neck  (page 
228)  while  it  influences  the  heart,  bronchi  and  stomach,  is 
absolutely  without  any  influence  on  the  percussion  sound  of 
the  intestine. 

THE  INTESTINAL  REFLEX  OF  CONTRACTION. 

This  reflex  consists  of  a  contraction  of  the  intestine  and 
is  evidenced  by  dullness  on  percussion  supplanting  the 
tympanitic  tone  prior  to  the  eli citation  of  the  manceuver. 
Of  all  the  visceral  reflexes  described  by  the  author,  this 
particular  reflex  is  of  longest  duration.  In  some  individuals 
it  may  persist  for  five  or  more  minutes,  and  it  is  more  evident 
and  longer  in  duration  in  children  than  in  adults.  It  is 

325 


Spondylotherapy 

best  elicited  by  concussion  or  sinusoidalization  of  the  spines 
of  the  first  three  lumbar  vertebrae.  Firm  and  deep  pressure 
alongside  of  the  spines  of  the  first  three  lumbar  vertebrae 
(Fig.  48)  will  also  evoke  this  reflex;  pressure  on  the  right 
side  of  the  spines  in  question  will  contract  the  intestine 
only  on  the  right  side,  whereas  pressure  on  the  left  side 
will  only  influence  the  intestine  on  that  side. 

Concussion  of  the  spines  in  question,  however,  evokes 
contraction  of  the  intestine  on  both  sides. 

THE  INTESTINAL  REFLEX  OF  DILATATION. 

This  reflex  consists  of  a  dilatation  of  the  intestine  and 
may  be  elicited  in  one  of  the  following  ways : 

1.  By  irritation  of  the  skin  of  the  abdomen.    Here  the 
intestinal  dilatation  is  very  circumscribed  and  practically 
limited  to  the  area  of  cutaneous  irritation. 

2.  By  firm  and  deep  pressure  at  the  side  of  the  spine 
of  the  nth  dorsal  vertebra.    Here  the  intestinal  dilatation 
is  limited  to  either  the  entire  right  or  left  side  of  the  abdomen 
dependent  on  the  side  subjected  to  pressure. 

3.  By  concussion  or  sinusoidalization  of  the  spine  of  the 
nth   dorsal   vertebra.     Concussion   is   more   potent   than 
sinusoidalization  in  discharging  this  reflex.    Here  the  intes- 
tinal dilatation  involves  all  of  the  intestine.    The  reflex  of 
dilatation  is  less  pronounced  and  of  shorter  duration  than 
its  counter-reflex  of  contraction. 

DISEASES  OF  THE  INTESTINES. 

It  is  generally  conceded  by  the  gastro-enterologist  that 
in  intestinal  and  gastric  diseases,  the  chemical  or  digestive 
functions  are  subservient  to  the  more  important  motor 
functions.  In  the  functional  intestinal  diseases,  one  again 
notes  muscles  in  antagonism  (page  n),  and  the  anomaly 

326 


Constipation 

in  function  is  expressed  by  the  predominant  action  of  either 
the  longitudinal  or  circular  muscular  fibers.  The  movements 
of  the  intestines  as  revealed  to  us  by  the  physiologist  are  of 
little  or  no  clinical  value.  The  chief  form  of  intestinal 
movement  is  known  as  peristalsis.  The  peristaltic  move- 
ment is  essentially  a  constriction  of  the  intestinal  wall,  com- 
mencing at  a  definite  point  and  passes  downward  from 
segment  to  segment,  whereas  the  parts  behind  the  advancing 
zone  of  constriction  relax  slowly.  The  physiologist  does 
not  account  for  the  action  of  the  longitudinal  fibers  in 
peristalsis,  but  assumes  that,  insomuch  as  constriction  is  the 
attribute  of  the  circular  layer  of  muscles,  the  latter  layer  is 
the  chief  factor  in  peristalsis. 

CONSTIPATION. 

In  one  class  of  patients,  constipation  may  exist  without 
any  symptoms,  whereas  others  complain  of  headache, 
anorexia,  lassitude,  mental  depression,  etc.  The  latter 
symptoms  have  been  dignified  by  the  term  copremia,  which 
is  supposed  to  indicate  fecal  poisoning.  The  fetich  of  many 
neurasthenics  is  the  water-closet,  and  the  elysium  of  others 
is  a  purgative.  It  is  easier  to  take  a  simple  pill  than  to 
pursue  a  prolix  dietetic  regime,  hence  the  prestige  of  the 
purgative  habit. 

What  constitutes  constipation?  We  do  not,  as  a  rule, 
seek  to  analyze  this  question,  and  content  ourselves  with  the 
bare  statement  of  the  patient.  Grant  suggests  the  following 
test  for  constipation :  The  patient  is  given  a  tablespoonful 
of  animal  charcoal.  Normally  it  appears  in  the  stools  in 
twenty-four  hours.  By  this  means,  even  though  the  patient 
affirms  that  he  is  or  is  not  constipated,  the  charcoal  test  will 
decide  the  question.  Dr.  C.  M.  Cooper  of  San  Francisco, 
resorts  to  the  following  test  to  determine  the  origin  of 

327 


S    p     o    n     d    y    I    o     the    r    a   p    y 

constipation.  The  test  is  based  on  the  fact  that,  in  the  norm, 
the  passage  of  charcoal  or  bismuth  (which  blacken  the  feces) 
from  the  stomach  to  the  rectum  is  attained  in  from  twelve 
to  forty-eight  hours.  If  more  than  seventy-two  hours  elapse 
before  colored  feces  are  detected  in  the  rectum,  constipation 
is  present.  Hertz,  of  London,  has  shown  that,  if  after  the 
lapse  of  forty-eight  hours  the  rectum  is  empty,  or,  as  Cooper 
shows,  if  the  sigmoidoscope  demonstrates  the  presence  of 
blackened  feces  lodged  in  the  sigmoid,  there  is  some  retarda- 
tion from  the  middle  of  the  transverse  colon.  If  the  feces 
lodge  in  the  rectum  longer  than  twenty -four  hours,  then  the 
constipation  is  rectal  in  origin,  dependent  on  one  of  the 
following  causes:  Loss  of  the  reflex  of  defecation  from 
anesthesia  or  neglect  (indolence,  false  pride,  pain  of  fissures 
or  hemorrhoids),  atony  or  paresis  of  the  rectum  and  weak- 
ness of  the  voluntary  muscles  of  defecation. 

One  must  differentiate  two  forms  of  constipation :  atonic 
and  spastic.  In  some  instances  the  latter  are  combined, 

ATONIC  CONSTIPATION  is  recognized  by  the  dilated 
intestines  which  cause  a  protuberance  of  the  abdomen  and 
percussion  of  the  latter  yields  a  tympanitic  sound.  Here, 
concussion  of  the  spines  of  the  first  three  lumbar  vertebrae, 
fails  to  yield  as  in  the  norm  a  decided  intestinal  reflex  of 
contraction  as  revealed  by  the  dull  percussion  note.  Not 
only  are  we  thus  able  objectively  to  determine  this  form  of 
constipation,  but  can  also  say  what  part  of  the  bowel  is 
implicated.  Very  often  the  dullness  is  obtained  only  over 
the  ascending  or  descending  colon,  showing  that  wherever 
dullness  is  obtained,  that  portion  of  the  intestinal  canal  is 
not  involved  in  atonic  constipation. 

SPASTIC  CONSTIPATION  is  less  frequent  than  the  atonic 
form.  The  former  is  caused  by  a  tonic  contraction  of  in- 
testinal segments  which  hold  back  fecal  masses,  whereas 

328 


Treatment      of      Constipation 

the  latter  is  dependent  on  an  inherent  enfeeblement  of  the 
intestinal  musculature.  There  is  always  a  feeling  in  the 
spastic  form  as  if  the  evacuation  were  unsatisfactory.  The 
patients  press  a  great  deal  at  stool  and  evacuate  long,  thin 
and  flattened  fecal  masses. 

On  palpation  of  the  abdomen  one  may  detect  localized 
contractions,  especially  of  the  transverse  colon  (corde  colique). 
The  implicated  intestinal  segment  may  be  rolled  under  the 
finger  like  a  cord.  Percussion  over  the  spastic  intestinal 
areas  yields  a  dull  in  lieu  of  a  tympanitic  sound.  Normally, 
when  one  scratches  the  abdominal  skin  over  a  dull  intestinal 
area,  or  by  a  few  blows  directed  against  the  epigastrium,  the 
dullness  becomes  tympanitic,  owing  to  temporary  dilatation 
of  the  intestine  (intestinal  reflex  of  dilatation).  The  per- 
cussion sound  of  the  spastic  intestine  does  not  change.  As 
a  rule,  the  spastic  form  does  not  lead  to  meteorism,  yet  in 
rare  instances,  there  may  be  symptoms  corresponding  to 
ileus  and  even  celiotomy  has  been  performed  by  mistake. 

In  the  spastic  form  not  only  are  cathartics  useless,  but 
they  accentuate  the  symptoms.  When  olive  oil  is  effective 
in  constipation  in  tablespoonful  doses  one-half  hour  before 
each  meal,  it  is  almost  diagnostic  of  the  spastic  form  of 
constipation. 

TREATMENT  OF  CONSTIPATION. 

Whatever  treatment  is  employed  in  this  condition,  one 
must  always  conciliate  a  psychic  factor.  The  psychic  factor 
takes  into  consideration  the  fact  that  the  desire  to  go  to 
stool  is  a  habit.  Habit  in  itself  is  a  great  economizer  of 
nerve-force,  for  it  is  automatic  in  action  and  reduces  cerebral 
participation  to  a  minimum. 

Thought  directed  toward  a  part  will  increase  its  functional 
activity.  The  mental  state  influences  the  intestinal  canal 

329 


Spondylotherapy 

and  one  may  recall  the  frequency  of  nervous  diarrhoea. 
The  diarrhoea  of  students  before  an  examination,  of  nervous 
women  and  men  during  transient  periods  of  excitement,  etc., 
is  of  this  nature.  Canstatt  tells  of  a  surgeon  who  had  an 
attack  of  diarrhoea  before  every  important  operation. 

From  what  has  preceded,  the  treatment  of  atonic  con- 
stipation consists  in  methods  which  have  for  their  object  the 
elicitation  of  the  intestinal  reflex  of  contraction.  In  the 
experience  of  the  author,  the  latter  is  best  elicited  by  sinu- 
soidalization  or  concussion  of  the  spines  of  the  first  three 
lumbar  vertebrae.  Concussion  appears  to  be  more  effective 
in  the  treatment  of  atonic  constipation.  If  the  sinusoidal 
current  is  employed,  one  electrode  is  fixed  over  the  sacrum 
and  the  other  over  the  spines  of  the  first  three  lumbar 
vertebras.  Strong  currents  must  be  used  and  the  daily  seances 
should  last  fully  fifteen  minutes.  Within  a  week,  usually, 
the  treatment  is  effective,  but  must  be  continued  thereafter 
less  often. 

Spastic  constipation  is  remedied  by  the  method  for 
eliciting  the  intestinal  reflex  of  dilatation,  viz.,  sinusoidaliza- 
tion  or  concussion  of  the  spine  of  the  nth  dorsal  vertebra. 

When  neither  form  of  constipation  predominates,  sinu- 
soidalization  or  concussion  at  the  same  seance  may  alternate 
between  the  spine  of  the  nth  dorsal  vertebra  to  stimulate 
the  longitudinal  muscular  fibers  and  the  spines  of  the  first 
three  lumbar  vertebras  to  excite  contraction  of  the  circular 
fibers  of  the  intestines. 

INTESTINAL  NEUROSES. 

Among  the  motor  neuroses  favorably  influenced  by  the 
methods  suggested  in  this  work  are  the  following : 

i.  NERVOUS  DIARRHOEA. — This  condition  presumes  an 
absence  of  all  anatomic  changes  in  the  intestinal  wall.  The 

330 


L      i     v      e      r-Reflexes 

subjects  are  usually  neuropaths.  The  treatment  consists  of 
alternate  toning  of  the  circular  (concussion  or  sinusoidaliza- 
tion  of  the  spines  of  the  first  three  lumbar  vertebrae)  and 
longitudinal  muscular  fibers  of  the  intestines  (spine  of  the 
nth  dorsal  vertebra). 

2.  PERISTALTIC  UNREST. — In  this  condition    (tormina 
intestinorum)  patients  suffer  from  loud  noises,  which  may 
often  be  heard  by  others.    The  peristaltic  movements  may 
be  so  loud  as  to  interfere  with  sleep.    The  movements  are 
often  visible  and  may  be  palpated.     The  same  treatment 
may  be  used  as  indicated  in  nervous  diarrhoea. 

3.  ENTEROSPASM. — In    this    condition    the    intestinal 
spasticity  may  be  limited  or  diffused,  and  in  the  latter 
instance  the  abdomen  is  retracted. 

Enteralgia  is  quite  independent  of  the  colicky  pains 
observed  in  enterospasm  and  is  caused  by  a  tetanic  contrac- 
tion of  the  enteric  musculature.  The  treatment  in  both 
affections  consists  of  relaxing  the  spasm  by  concussion  or 
sinusoidalization  of  the  spine  of  the  nth  dorsal  vertebra. 

4.  NERVOUS  CONSTIPATION. — This  is  frequently  asso- 
ciated with  atony  of  the  intestines  and  the  subjects  are 
usually   hysterical  and  suffer  paroxysmally  from  meteorism. 
There  is  always  a  tendency  to  meteorism  whenever  there  is 
any  weakness  of  the  intestinal  musculature.     The  treatment 
of  this  condition  is  similar  to  that  described  under  nervous 
diarrhoea. 

THE  LIVER. 

There  are  two  LIVER  REFLEXES  :  that  of  contraction  and 
that  of  dilatation.  The  liver  re/lex  of  contraction  may  be 
elicited  in  three  ways: 

1.  By  irritation  of  the  skin  over  the  liver. 

2.  By  fixing  a  pleximeter  anywhere  in  the  hepatic  region 

331 


S   p 


n 


d    y    I    o     t    h 


r    a   p    y 


and  striking  the  pleximeter  a  series  of  vigorous  blows  with 
a  hammer. 

3.  By  concussion  or  sinusoidalization  of  the  spines  of 
the  first  three  lumbar  vertebrae. 

The  latter  manoeuver  is  the  most  effective.  By  any  of 
the  foregoing  methods,  percussion  demonstrates  (Fig.  87) 
a  contraction  of  the  liver.  In  percussing  the  lower  border 


FIG.  87. — Demonstrating  the  liver  reflex  of  contraction.  The  continuous  lines 
represent  the  borders  of  the  organ  before  and  the  interrupted  lines  the  borders  after 
eliciting  the  liver  reflex  of  contraction.  The  latter  reflex  in  this  patient  was  elicited 
by  concussion  of  the  spines  of  the  first  three  lumbar  vertebrae.  The  liver  in  the 
mammary  line  measured  12  cm.  and  was  reduced  to  7  cm. 


of  the  liver,  the  dullness  of  the  lower  border  of  the  organ  is 
facilitated  by  inclining  the  body  backwards  or  by  having  an 
assistant  fix  the  hand  upon  the  spinal  column  to  prevent 
vibrations  of  the  latter  (Page  80). 

The  liver  re/lex  of  dilatation  is  evidenced  by  an  enlarge- 
ment of  the  organ  subsequent  to  the  execution  of  the  following 
manceuvers : 

332 


Pathologic    Physiology    of  Liver 

1.  By  deep  and  firm  pressure  with  the  finger  to  the 
right  of  the  spinous  process  of  the  nth  dorsal  vertebra 
(Fig.  48). 

2.  By  sinusoidalization  or  concussion  of  the  spine  of 
the  nth  dorsal  vertebra.    This  is  the  more  effective  of  the 
two  methods. 


FIG.  88. — Illustrating  enlargement  of  the  liver  by  concussion  of  the  spine  of 
the  nth  dorsal  vertebra.  The  continuous  lines  represent  the  area  of  dullness 
before,  and  the  interrupted  lines  the  area  after  eliciting  the  liver  reflex  of  dilatation. 
The  liver  in  the  mammary  line  measured  12  cm.  and  was  increased  to  16  cm. 

PATHOLOGIC  PHYSIOLOGY. 

Circulatory  Disturbances. — During  digestion  there  is  a 
physiologic  congestion  of  the  liver,  but  in  persons  who  eat 
and  drink  to  excess,  this  congestion  may  become  pathologic 
and  may  even  conduce  to  organic  change.  The  fullness  or 
distress  in  the  right  hypochondrium,  to  which  reference  is 
frequently  made  by  dyspeptics,  may  be  caused  as  Osier 
suggests,  by  hyperemia  of  the  liver.  The  amount  of  blood 
contained  in  the  liver  is  equivalent  to  one -fourth  the  amount 

333 


Spondyloth     e     r    a    p    y 

of  blood  contained  in  the  body.  During  digestion  this 
amount  is  very  much  increased,  hence  the  drowsiness  after 
eating,  especially  in  dyspeptics,  the  result  of  brain-anemia 
from  portal  congestion  and  the  cold  extremities  and  chilly 
sensations.  Hyperemia  of  the  organs  has  been  noted  in 
suppression  of  the  menses.  Passive  congestion  is  frequent 
in  all  conditions  leading  to  venous  stasis  in  the  right  ventricle 
of  the  heart,  and  is  associated  with  swelling  of  the  organ. 

HEPATIC  TOXEMIA. — Any  hepatic  disease  may  be  associ- 
ated with  a  variety  of  toxic  symptoms  connected  with  the 
nervous  system. 

In  the  norm,  the  poisonous  substances  in  the  intestinal 
canal  are  either  not  absorbed  or,  if  they  are,  they  are  made 
innocuous  and  rapidly  excreted.  Auto-protection  of  the 
organism  against  self -poisoning  is  achieved  by  organs  which 
either  arrest  or  transform  the  poisons  or  eliminate  them. 

The  organs  of  defense  practically  represent  the  bodily 
resistance.  This,  equationally  expressed  for  germ-infection, 
is  applicable  to  auto-poisoning,  viz.: 

PTA 

T-V 

R 

D,  the  disease,  equals  P,  the  poison,  multiplied  by  T, 
its  toxicity,  multiplied  by  A,  its  amount,  the  product 
being  R,  the  resistance  of  the  individual  attacked.  The 
liver  is  unquestionably  the  chief  organ  of  defense.  It 
converts  the  poisons  into  non-toxic  and  assimilable  sub- 
stances, niters  them,  and  excretes  them  in  the  bile.  When 
the  liver-function  becomes  insufficient,  the  poisons  des- 
tined for  destruction  enter  the  blood,  and  the  clinical 
picture  of  hepatic  toxemia  results.  If  the  liver  is  ex- 
cluded from  the  general  circulation  by  connecting  the 
portal  vein  with  the  inferior  vena  cava,  nervous  manifes- 
tations and  even  death  may  follow  the  ingestion  of  meat. 
The  condition  known  as  autointoxication  is,  practically 
speaking,  an  hepatic  toxemia. 
334 


In  t  e  s  t  i  n  a  I    Autointoxication 

Intestinal  autointoxication,  as  we  now  comprehend  it, 
may  be  briefly  summarized  as  follows:  During  digestion, 
a  number  of  poisons  or  enterotoxins  are  manufactured  as  a 
result  of  putrefaction  of  albuminoid  food  in  the  intestines. 
These  enterotoxins  attain  the  liver  by  way  of  the  entero- 
hepatic  circulation  where  they  are  made  innocuous.  From 
the  liver  they  pass  into  the  general  circulation  and  are  excreted 
in  the  urine.  If  albuminoid  putrefaction  is  excessive,  or  if  the 
liver  and  kidneys  (notably  the  former),  prove  inadequate  in 
either  neutralizing  or  excreting  the  poisons,  autointoxication 
ensues.  Intoxication  is  expressed  by  a  motley  group  of 
symptoms,  which  often  parade  under  the  equivocal  designa- 
tion, neurasthenia.  Now,  this  conception  of  intestinal 
autointoxication  is  only  partially  correct.  While  the  usual 
enterotoxins  are  bacterial  products,  there  are  also  poisonous 
albumoses,  i.  e.,  intermediate  products  manufactured  in  the 
digestion  of  albuminous  foodstuffs.  It  is  well  known  that 
when  peptones  and  albumoses  (normal  products  of  digestion) 
are  injected  directly  into  the  blood,  they  are  poisonous  and 
even  fatal  in  their  effects.  Falloise  has  recently  had  an 
excellent  opportunity  of  studying  this  subject  in  a  patient 
with  a  fistula  of  the  small  intestine.  He  concludes  that 
albuminoid-putrefaction  is  not  the  only  process  concerned 
in  autointoxication,  and  that  an  aqueous  extract  of  the  con- 
tents of  the  small  intestine  is  infinitely  more  toxic  than  an 
extract  made  from  the  contents  of  the  large  intestine. 
Hence,  if  we  accept  the  prevailing  opinion  that  putrefaction 
of  the  albuminous  molecule  is  limited  in  the  norm  to  the 
large  intestine,  factors  other  than  putrefaction  of  the  albu- 
minous molecule  must  be  concerned  in  intestinal  autointoxi- 
cation. 

Contrary  to  current  belief,  I  have  found  that,  in  those 
suffering  from  self-poisoning,  diarrhoea,  or  at  any  rate, 

335 


Spondylotherapy 

looseness  of  the  bowels  prevails  rather  than  constipation, 
and  it  appears  as  if  this  were  a  compensatory  attempt  on 
the  part  of  the  organism  to  rid  itself  of  noxious  products. 
Strassburger  has  shown  that  retarded  bowel-action  rather 
indicates  diminished  products  of  decomposition  which  norm- 
ally stimulate  the  action  of  the  intestines.  If  one  were 
guided  in  the  diagnosis  of  autointoxication  by  the  statements 
of  the  patient,  the  condition  would  rarely  be  recognized. 
The  fact  is,  the  patients  infrequently  complain  of  symptoms 
of  indigestion.  It  is  only  in  aggravated  cases  that  one 
encounters  the  conventional  symptoms  of  dyspepsia.  In 
most  instances,  nervous  symptoms  precede  the  local  signs 
of  indigestion. 

Another  supposed  classical  symptom  of  the  affection  is 
indicanuria;  yet  my  experience  shows  that  it  is  comparatively 
infrequent. 

If  one  electrode  of  a  sinusoidal  current  is  placed  over  the 
sacrum  and  the  other  over  the  spines  of  the  first  three 
lumbar  vertebrae,  or,  if  the  spines  in  question  are  concussed, 
one  evokes  the  liver  reflex  of  contraction.  Either  manceuver 
will  promote  the  excretion  of  indican  in  the  urine  and  its 
presence  in  the  urine  may  be  demonstrated  after  a  single 
seance  lasting  fifteen  minutes,  even  though  previously  absent. 
Naturally  the  urine  must  be  voided  before  and  after  the 
application  of  the  current  and  the  specimens  compared  after 
examination  is  made  for  indican.  For  the  examination  of 
the  latter  I  prefer  the  simple  test  recommended  by  Porter: 

Add  in  a  test-tube  equal  quantities  of  urine  and 
chemically  pure  hydrochloric  acid.  To  this  mixture  add 
three  drops  of  a  one-half  per  cent  solution  of  potassium 
permanganate.  If  indican  is  present  in  the  urine  there 
will  be  formed  a  purplish  cloud  in  the  fluid  in  the  test- 
tube.  Then  add  a  few  drops  of  chloroform  then  one  drop 

336 


In  t  e  s  t  i  n  a  I    Autointoxication 

more  of  the  potash  solution  and  a  few  drops  more  of 
chloroform  and  shake  vigorously.  The  deep-blue  color 
resulting  is  due  to  precipitation  of  indican  by  chloroform 
and  the  amount  and  intensity  of  the  precipitated  indican 
determine  the  extent  of  the  putrefactive  changes  going 
on  in  the  alimentary  tract. 

SPLANCHNIC  NEURASTHENIA. — In  his  book  on  this 
subject,  the  author  has  described  a  condition  dependent  on 
intraabdominal  venous  congestion  superinduced  by  in- 
sufficiency of  the  splanchnic  vaso-motor  mechanism,  and 
that  the  neurasthenic  symptoms  resulting  therefrom  may  be 
corrected  by  relief  of  the  congestion  and  by  manoeuvers 
which  will  increase  the  efficiency  of  the  liver  as  an  organ  of 
defense.  The  fact  is,  splanchnic  neurasthenia  is  intimately 
associated  with  autointoxication.  When  this  venous  con- 
gestion exists  it  interferes  with  a  proper  supply  of  arterial 
blood,  and  in  consequence,  the  tissues  and  organs  are  bathed 
in  pools  of  stagnant  blood — they  are  practically  asphyxiated. 
Again,  the  impeded  circulation  cannot  remove  the  toxic 
products  of  digestion,  and  instead  of  the  latter  being  at  once 
conveyed  to  organs  of  elimination  like  the  kidneys,  they  are 
arrested  or  transformed  by  organs  like  the  liver,  which  soon 
prove  inadequate  to  discharge  their  anti -toxic  function;  then 
we  have  the  creation  of  symptoms  which  belong  to  the 
category  of  self -poisoning. 

TREATMENT. 

CIRCULATORY  DISTURBANCES. — Every  condition  conduc- 
ing to  a  stagnation  of  blood  in  the  right  "heart  is  eventually 
followed  by  passive  congestion  of  the  liver.  Merklen  and 
Heitz  have  shown  that  coincident  with  the  elicitation  of  the 
heart  reflex,  there  is  a  reduction  in  the  size  of  the  liver 
(Fig.  58).  Here,  the  heart  momentarily  awakens  from  its 
lethargy  and  by  pumping  an  augmented  quantity  of  blood 

337 


Spondylotherapy 

into  the  circulation  temporarily  reduces  the  congestion  of 
the  liver. 

Many  Anglo-Indian  physicians  directly  aspirate  eighteen 
or  more  ounces  of  blood  directly  from  the  liver  and  it  is 
claimed  that  excellent  results  ensue  from  this  hepato-phle- 
botomy.  This  method  was  suggested  by  observing  the 
reduction  in  the  volume  of  the  liver  after  bleeding  from  piles. 

Now,  in  many  instances,  one  may  regard  congestion  of 
the  liver  as  a  process  of  compensation,  the  liver  acting  as  a 
reservoir  for  the  redundant  blood  which  correspondingly 
reduces  the  work  of  the  heart. 

By  enlarging  the  volume  of  the  liver  by  concussion  of  the 
spine  of  the  nth  dorsal  vertebra,  the  patient  may  be  bled 
into  his  own  vessels  for,  even  in  the  norm,  this  organ  contains 
approximately  one-fourth  of  the  amount  of  blood  in  the  body. 

In  other  instances,  the  organ  may  be  depleted  by  exciting 
the  liver  reflex  of  contraction  by  sinusoidalization  or  con- 
cussion of  the  spinous  processes  of  the  first  three  lumbar 
vertebrae. 

INTESTINAL  AUTOINTOXICATION. — Food  as  a  factor  in 
the  treatment  of  autointoxication  is  a  much-abused  com- 
modity. Someone  has  observed  that  the  ultimate  trend  of 
the  physician  was  to  prove  that  even  food  was  poisonous  and 
what  has  been  suggested  as  a  facetious  prognostication, 
appears  to  have  been  endowed  with  reality,  when  one 
seriously  contemplates  the  endeavors  of  dietetic  revolution- 
ists. Many  dietetic  vagaries  are  as  consistent  as  the  per- 
fervid  plea  of  the  poet  Shelley,  who  wanted  us  to  become 
vegetarians  and  marry  our  sisters.  By  opposing  alimentary 
insufficiency  we  possess  a  formidable  weapon  in  immunizing 
the  tissues  against  interminable  dietetic  insults.  One  must 
not  forget  that  there  is  such  a  condition  as  "indigestion 
toxemia,"  due  either  to  an  excessive  production  of  poisons 

338 


Intestinal    Autointoxication 

or  to  enfeeblement  of  the  defenses.  Thus  there  is  an  hepatic 
as  well  as  a  gastric  and  intestinal  dyspepsia  and  the  liver 
dare  not  be  ignored  even  in  the  treatment  of  an  ailment  so 
plebeian  as  dyspepsia. 

Intestinal  asepsis  is,  in  my  experience,  a  purely  theoretic 
conception  which  is  rarely  realized  in  practice.  Intestinal 
antisepsis  is  difficult,  if  not  impossible,  for  the  following 
reasons:  i.  An  antiseptic  strong  enough  to  destroy  germs 
is  equally  destructive  to  the  intestinal  mucosa.  2.  Germicides 
will  destroy  the  innocent  germs  which  are  concerned  in 
digestion.  3.  Germicides  are  rapidly  absorbed  or  are  made 
chemically  inert.  Recourse  is  also  had  to  purgatives,  but 
they  often  accentuate  the  symptoms  of  autointoxication 
because  they  concentrate  the  poisons  already  absorbed  and 
remove  the  intestinal  epithelium  and  mucus  which  practically 
act  as  barriers  against  the  absorption  of  enterotoxins.  We 
have  discarded  the  swab  in  infectious  diseases  of  the  throat, 
for  the  reason  that  it  mechanically  injures  the  membrane  of 
the  throat  and  thus  opens  up  new  portals  of  infection.  In 
this  sense,  the  purgative  is  essentially  an  intestinal  swab. 

Intestinal  autointoxication  is  a  misnomer;  the  term  of 
qualification  refers  only  to  the  site  where  the  poisons  are 
manufactured. 

The  offending  viscus  in  autointoxication  is  usually  the 
liver  and,  if  this  organ  is  made  equal  to  the  task  of  destroying 
the  poisons,  the  subject  of  self -poisoning  would  be  simplified. 

In  autointoxication  the  liver  is  congested,  enlarged  and 
extremely  sensitive  to  pressure ;  in  fact,  when  the  latter  signs 
are  present  in  the  absence  of  organic  disease,  we  are  in  the 
possession  of  the  most  positive  evidence  of  hepatic  inade- 
quacy. Reference  has  already  been  made  to  the  increased 
excretion  of  indican  following  the  elicitation  of  the  liver 
reflex  of  contraction  (page  336)  and  the  manceuver  for 

339 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

exciting  the  latter  is  the  method  employed  by  the  author 
in  correcting  hepatic  inadequacy  in  autointoxication.  To 
best  elicit  the  reflex  in  question  sinusoidalization  or  concus- 
sion of  the  spines  of  the  first  three  lumbar  vertebrae  is 
executed  daily. 

The  results  even  after  a  single  treatment  is  evident ;  the 
liver  is  reduced  in  volume  and  palpation  shows  diminished 
tenderness. 

It  would  be  manifestly  inconsistent  were  the  author  to 
contend  that  the  method  suggested  is  curative  to  the  exclusion 
of  other  methods  of  treatment.  On  the  contrary,  he  is  more 
disposed  to  say  that  concussion  or  sinusoidalization  of  the 
lumbar  spines  is  more  effectual  as  an  individual  method  of 
treatment. 

Excessive  albuminous  food,  that  is  to  say,  a  diet  con- 
taining a  large  quantity  of  meats  and  eggs,  augments 
intestinal  putrefaction,  and  even  though  the  organs  of 
defense  are  relatively  normal,  they  are  incapable  of  perform- 
ing their  functions  when  an  increased  burden  is  thrust  upon 
them. 

It  will  be  necessary  for  us  to  briefly  consider  other 
methods  of  treatment  in  autointoxication.  Some  contend 
that  if  indican  can  be  detected  in  the  urine,  even  by  a  feeble 
reaction,  it  is  an  indication  that  it  is  excreted  in  excessive 
quantity.  Indican  in  the  urine  (indicanuria)  suggests  bac- 
terial putrefaction  of  the  proteid  substances  in  the  intes- 
tines, for  in  perfect  digestion  of  the  proteids,  it  cannot  be 
detected  in  the  urine. 

Intestinal  putrefaction  as  already  suggested  results  from 
the  action  of  proteolytic  bacilli  on  albuminous  food  and  the 
primary  indication  in  treatment  is  to  modify  the  culture 
medium  of  the  intestine  so  as  to  render  it  inimical  to  the 
germs  in  question. 

340 


Intestinal    Autointoxication 

The  best  and  most  certain  method  of  treatment  is  by  means  of  an 
antiputrid  regime. 

It  has  been  suggested  that  a  sterile  regime  will  destroy  the  virulence 
of  the  bacterial  flora  of  the  intestine,  but  observations  show  that 
sterile  food  will  diminish  but  does  not  completely  inhibit  intestinal 
putrefaction. 

An  aseptic  regime  is  best  attained  by  the  avoidance  of  crude 
vegetables  and  fruits,  for  no  matter  how  thoroughly  they  are  washed 
they  still  remain  contaminated. 

The  cooking  of  foods  will  diminish  the  danger  of  infection  by 
destroying  bacterial  growths  and  larger  parasites  (tapeworms  and 
trichinae).  The  cooking  of  vegetable  foods  breaks  up  the  starch 
grains,  bursting  the  cellulose  and  thus  permitting  the  digestive  fluids 
to  come  into  immediate  contact  with  the  granulose. 

ANTIPUTRID  REGIME. — As  before  remarked,  this  is  the  most 
satisfactory  means  of  antagonizing  intestinal  putrefaction.  The 
putrescent  aliments  are  the  proteids  and  if  the  latter  could  be  completely 
eliminated,  there  would  be  no  putrefaction,  and  consequently,  no 
intestinal  autointoxication.  All  investigations  show  that  intestinal 
putrefaction  augments  parallel  with  the  quantity  of  albuminous 
foodstuffs.  We  know,  however,  that  the  proteids  or  albuminous 
foodstuffs  are  true  tissue-builders  and  repairers  and  consequently 
cannot  be  eliminated  without  compromising  nutrition.  We  know, 
furthermore,  that  the  proteid  requirements  of  the  individual  have  been 
exaggerated  and  that  the  experiments  of  Professor  Chittenden  show 
that  men  can  maintain  health  and  muscular  efficiency  for  long  periods 
on  about  half  the  amount  of  proteid  which  is  usually  consumed.  It 
would  be  difficult  now  to  maintain,  as  did  Herbert  Spencer,  that  the 
consumers  of  meat  showed  superior  physical  strength  to  the  consumers 
of  rice,  which  would  be  equivalent  to  saying  the  Russians  demonstrated 
more  physical  endurance  than  the  Japanese.  One  may  conclude 
conservatively  that  we  ordinarily  consume  more  proteid  food  than  is 
necessary  and  that  ingested  in  excess,  it  is  either  conserved  for  future 
uses  of  the  economy,  or  remaining  undigested,  it  must  be  reduced  by 
bacterial  digestion.  Instead  of  the  individual  requiring  one  hundred 
and  twenty  grams  daily  of  proteid  according  to  the  diet  table  of 
Moleschott,  or  one  hundred  grams  according  to  the  diet  table  of  Ranke, 

341 


Spondylotherapy 

the  amount  of  proteid  may  be  reduced  considerably  without  prejudice 
to  the  individual. 

If  an  individual  were  desirous  of  taking  his  daily  supply  (100 
grams)  of  proteid  in  the  form  of  meat,  it  would  be  necessary  for  him 
to  consume  a  little  more  than  one  pound  (500  grams)  of  meat.  It 
was  at  one  time  supposed  that  fats  exercised  no  influence  on  intestinal 
putrefaction,  but  more  recent  experiments  have  demonstrated  that 
this  observation  is  faulty  and  that  fats  do  increase  intestinal  putre- 
faction. 

The  lacto-farinaceous  diet  of  Combe  is  the  antiputrid  regime  par 
excellence  in  the  treatment  of  autointestinal  intoxication;  it  acts  not 
by  any  destructive  influence  on  the  intestinal  flora,  but  seeks  only  to 
modify  the  soil  in  which  the  microbes  live. 

MILK. — Of  all  aliments,  milk  is  probably  the  most  resistant  to 
putrefaction,  and  it  has  been  found  by  Winternitz  that  if  a  certain 
quantity  of  milk  is  given  with  a  meat  diet,  it  will  diminish  the  pro- 
duction of  enterotoxins.  Milk  owes  its  antiputrid  properties  to  the 
lactose  which  it  contains  and  which,  under  the  influence  of  the  aerobic 
bacilli  of  the  small  intestine  (coil  and  lactis  aerogenes)  is  decomposed 
into  succinic  and  lactic  acids.  These  acids  inhibit  the  action  of  the 
proteolytic  bacilli  in  the  large  intestine  from  acting  on  the  albuminous 
foodstuffs.  Cow's  milk  contains  about  3.5  per  cent  of  proteids 
(chiefly  caseinogen)  against  12.2  per  cent  in  the  white  of  eggs  and 
about  20  per  cent  in  meats. 

I  find  that  some  individuals  cannot  tolerate  even  small  quantities 
of  milk  (raw  or  boiled)  without  causing  diarrhoea.  In  such  instances, 
I  employ  lactose  (milk  sugar).  Cow's  milk  contains  5  per  cent  of 
lactose;  hence  if  the  individual  will  take  about  400  grains  of  lactose 
at  each  meal,  he  will  have  consumed  an  amount  equal  to  about  three 
pints  of  milk  daily.  Very  often  raw  milk  is  tolerated  when  boiled 
milk  is  not. 

It  has  also  been  proposed  to  substitute  milk  by  a  number  of 
aliments  which  already  contain  lactic  and  succinic  acids  and  many  of 
them  are  more  digestible  than  the  ordinary  cow's  milk.  They  are  as 
follows: 

1.  Curdled  milk. 

2.  Whey. 

3.  Buttermilk. 

342 


In  t  e  s  t  i  n  a  I    Autointoxication 

4.  Koumiss. 

5.  Kefir.  ' 

.6,    Fresh  cheese  (frontage  a  la  creme). 

Buttermilk,  owing  to  its  small  amount  of  fat  and  casein  (chief 
proteid  of  milk), is  a  very  desirable  product  in  autointoxication,  inso- 
much as  one  knows  that  these  substances  favor  putrefaction.  Again, 
the  presence  of  lactic  acid  and  lactose  enables  the  latter  to  produce 
lactic  acid  in  statu  nascenti.  Condensed  buttermilk  may  be  obtained 
in  flasks  containing  330  grams,  and  to  prepare  the  buttermilk  one 
mixes  the  contents  of  one  flask  with  660  grams  of  a  decoction  of  cereals, 
thus  obtaining  one  liter  of  porridge  (potage  au  babeurre). 

The  composition  of  Koumiss  varies  with  its  age,  containing  on 
the  first  day  about  .96  per  cent  of  lactic  acid  and  about  one  per  cent 
on  the  twenty-first  day  after  its  preparation.  It  contains  nearly  the 
same  percentage  of  alcohol  as  beer.  Koumiss  is  an  agreeable  and 
easily  digestible  preparation. 

Fresh  soft  cheese  contains  considerable  assimilable  casein  and 
therefore  subserves  a  useful  purpose  in  proteid  nutrition  and  it  has  all 
the  advantages  and  none  of  the  disadvantages  of  milk.  Thus  the 
soft  cheese  known  as  petit  suisse  contains  the  following:  Albumin  4 
per  cent ;  casein,  24  per  cent;  lactose,  2  per  cent ;  and  lactic  acid, 
.60  per  cent. 

FARINACEOUS  ALIMENTS. — Combe*  formulates  the  following 
conclusions: 

1.  The  carbohydrates,  or  sugary  foods,  prevent  proteid  putre- 
faction in  the  intestine. 

2.  That  in  natural  digestion,  the  farinaceous  foods  (rice,  farina 
of   cereals   and   their  derivatives)    surpass   all   other   carbohydrates 
because  they  are  less  easily  absorbed  and  they  penetrate  more  pro- 
foundly into  the  intestine   and    only  gradually  furnish  lactic  and 
succinic  acids. 

3.  That  the  maximum  quantity  of  farinaceous  food  must  be 
given  with  each  repast  and,  if  possible,  to  carry  out  this  cramming 
process,  this  food  must  be  given  five  or  six  times  a  day. 


*L' Auto-Intoxication  Intestinale,  Paris,  1907.    There  is  an  English  translation  of 
this  book  published  by  the  Rebman  Company. 

343 


S    p     on     d    y     I    o     t    h     e     r    a   p    y 

4.  Interdict  as  far  as  possible,  all  albuminous  foodstuffs  but 
choose  among  them  the  least  putrescent  (like  eggs)  and  when  they  are 
used,  combat  their  action  by  an  excess  of  farinaceous  food. 

5.  In  the  ordinary  forms  of  autointoxication,  milk  mixed  with 
farinaceous  food  is  better  supported  than  milk  alone. 

6.  Avoid  fats,  which  augment  putrefaction,  and  choose  butter  in 
preference. 

If  one  is  desirous  of  carrying  out,  if  only  for  test  purposes,  an 
antiputrid  regime,  one  may  select  the  following: 

1 .  Milk,  or  lactose  as  a  substitute. 

2.  Cooked  vegetables,  preferably  as  purges. 

3.  Preserved  or  cooked  fruits. 

4.  Weak  coffee,  tea  or  cocoa. 

5.  Toast  with  little  butter. 

6.  Farinaceous  foods  prepared  as  puddings,  or  otherwise. 

These  must  be  consumed  in  abundance. 

7.  Buttermilk  or  Koumiss. 

8.  Fresh  cream  cheese. 

Later,  if  the  condition  of  the  patient  is  ameliorated,  easily  digestible 
albuminous  foodstuffs  like  eggs,  ham  and  cold  meat,  together  with 
fresh  fruits  (preferably  bananas),  may  be  permitted. 

ANTAGONISTIC  MICROBES. — Ever  since  Metchnikoff  directed  atten- 
tion to  the  fact  that  sour  milk  microbes  are  antagonistic  to  the  microbes 
of  putrefaction,  it  is  quite  the  custom  in  France  to  employ  the  former 
in  the  treatment  of  autointoxication.  The  chief  characteristic  of  the 
intestinal  flora  of  the  autointoxicated,  is  the  marked  diminution  of 
the  saccharolytic  aerobic  bacilli  and  the  preponderance  of  the  pro- 
teolytic  anaerobic  varieties.  To  modify  the  foregoing  condition  a 
vegetarian  or  lacto-vegetarian  or  lacto-farinaceous  diet  is  indicated 
on  account  of  the  small  quantity  of  proteid  matter  which  it  contains 
and  the  lactic  acid  which  it  produces.  Another  method  is  to  feed  the 
subject  with  lactic  acid  ferments  or  microbes  which  are  innocuous 
but  exert  an  inhibitory  influence  on  the  microbes  of  putrefaction. 
There  are  now  several  lactic  acid  culture  mediums  on  the  market, 
but  many  of  them  seem  to  lose  their  therapeutic  action  when  prepared 
in  the  form  of  tablets  or  globules. 

344 


Splanchnic       Neurasthenia 

Unquestionably,  the  liquid  lactobacilline,  as  it  is  called,  is  the  most 
efficient.  It  may  be  taken  in  milk  or  water  directly  from  the  small 
bottles  in  which  it  is  sold,  and  one  bottle  (containing  about  half  a  tea- 
spoonful)  a  day  is  the  average  dose.  During  the  first  few  days, 
digestive  disorders  may  follow  its  use  but  soon  constipation  ceases, 
the  stools  lose  their  putrid  odor,  the  breath  sweetens  and  the  tongue 
becomes  cleaner.  The  signs  of  autointoxication  disappear  slowly 
but  surely.  To  make  these  good  results  permanent,  the  treatment 
is  continued  on  an  average  for  two  and  a  half  months.  The  ferment 
is  ordinarily  employed  in  association  with  the  diet,  although  some 
writers  claim  that  nearly  all  the  effects  can  be  secured  from  the  ferment 
alone.  According  to  Cohendy,  it  takes  about  six  days  before  the  lactic 
acid  microbes  change  the  intestinal  flora.  If  diarrhoea  is  caused  by 
intestinal  putrefaction,  it  is  said  to  be  arrested  by  this  bacterio-thera- 
peutic  method. 

If  lactic  acid  culture  mediums  cannot  be  obtained,  then  buttermilk 
or  koumiss  may  be  used.  Holt  suggests  the  following  formula  for 
the  domestic  manufacture  of  koumiss:  one  quart  of  fresh  milk,  one- 
half  ounce  of  sugar,  two  ounces  of  water  and  a  fresh  piece  of  yeast 
cake  (one-half  inch  square) ,  are  put  in  wired  bottles  and  kept  at  a 
temperature  between  60  and  70  degrees  F.  for  one  week.  The  bottles 
are  shaken  five  or  six  times  a  day.  They  are  then  put  on  ice  and 
kept  ready  for  use. 

This  bacterio-therapeutic  method  may  have  to  be  employed  to 
the  exclusion  of  the  laco-farinaceous  diet  for  there  are  some  individuals 
who  suffer  from  dyspeptic  symptoms  if  the  latter  is  pursued  too 
vigorously. 

SPLANCHNIC  NEURASTHENIA.  —  The  chief  abdominal 
symptoms  of  this  affection  are :  abdominal  sensitiveness,  ten- 
derness and  enlargement  of  the  liver,  and  gaseous  accumula- 
tions in  the  bowels.  The  dominant  symptoms  of  the  affection 
are  resident  in  the  nervous  system.  Depression,  or  as  it  is 
popularly  called,  an  attack  of  "the  blues,"  is  scientifically 
speaking,  an  exacerbation  of  splanchnic  neurasthenia  and 
coincident  with  the  depression,  there  is  hepatic  enlargement 
and  tenderness.  Eliciting  the  liver  reflex  of  contraction  will 

345 


S   p    o     n    d    y    I 


t    h 


r    a    p    y 


at  once  dissipate  partially  or  completely  the  liver  tenderness 
and  enlargement,  and  will  ameliorate  the  condition  of  the 
patient.  Splanchnic  neurasthenics  find  that  their  symptoms 
are  accentuated  after  meals  and  this  may  be  accounted  for 
by  the  augmented  amount  of  blood  in  the  liver  at  this  par- 
ticular time. 

The  factors  which  contribute   to  the  development  of 
splanchnic  neurasthenia  are  essentially  nerve -force  lacking 


FIG.  89. — Illustrating  the  cardio-splanchnic  phenomenon.  The  shaded  area 
indicates  the  dullness  obtained  after  vigorous  compression  of  the  abdomen.  The 
contiguous  area  is  the  superficial  area  of  cardiac  dullness. 

in  the  muscles  of  the  abdomen  and  in  the  nervous  mechanism 
which  regulates  the  supply  of  blood  in  the  abdominal  vessels. 
The  former  factor  indicates  reduced  intraabdominal 
tension,  for  the  greater  the  latter,  the  less  blood  will  be 
contained  in  the  abdominal  vessels.  It  is  for  this  reason, 
that  one  finds  in  splanchnic  neurasthenia  the  objective  signs 
of  reduced  intraabdominal  tension  (page  145).  There  is 

346 


Splanchnic       Neurasthenia 

another  sign  which  the  author  has  called  the  cardio -splanchnic 
phenomenon67  (Fig.  89).  There  is  a  tendency  of  the  blood 
to  accumulate  in  the  splanchnic  area,  with  consequent 
syncope. 

Like  the  generality  of  veins,  the  great  splanchnic  veins 
are  very  susceptible  to  pressure,  and  the  amount  of  blood 
within  them  is  greatly  influenced  by  the  pressure  of  the 
abdominal  walls.  Mere  pressure  of  the  latter  suffices  to 
squeeze  out  of  them  a  large  quantity  of  blood.  More 
blood  accumulates  in  the  splanchnic  veins  in  the  erect  than 
in  the  recumbent  posture,  and  it  is  not  an  uncommon 
observation  for  syncope  to  occur  in  bedridden  patients  who 
are  suddenly  constrained  to  get  out  of  bed.  The  removal 
of  stays  in  women  often  induces  a  feeling  of  faintness,  and 
the  same  symptom  may  occur  when  a  large  quantity  of 
ascitic  fluid  is  removed  and,  in  susceptible  subjects,  when 
the  bladder  is  emptied  or  feces  discharged. 

Hill  has  shown  that  in  consequence  of  some  failure,  the 
blood  gravitates  into  the  splanchnic  veins  from  the  right 
heart,  and  that  pressure  upon  the  abdomen  will  send  back 
the  blood  from  these  veins  to  the  right  heart,  and  thus  re- 
establish the  circulation. 

If  the  lower  sternal  region,  i.  <?.,  the  part  of  the  sternum 
contiguous  to  the  heart,  is  first  percussed,  the  sound  elicited 
is  one  of  resonance  or  hyperresonance ;  if  now,  one  makes 
vigorous  compression  of  the  abdomen,  percussion  again 
shows  that  the  region  in  question  has  become  dull  or  even 
flat.  This  is  the  cardio -splanchnic  phenomenon  and  is 
present  even  in  the  norm,  but  when  there  is  intraabdominal 
venous  congestion  as  in  splanchnic  neurasthenia,  this 
phenomenon  is  much  exaggerated  and  the  area  of  dullness 
is  more  diffused. 

By  percussing  the  lower  end  of  the  sternum  in  the  erect 

3*7 


Spondyloth     e     r    a    p    y 

posture,  one  obtains  a  resonance,  but  when  the  patient 
assumes  the  recumbent  posture,  a  dullness  supplants  the 
resonance.  This  is  the  attitudinal  cardio-splanchnic  phe- 
nomenon. It  is  present  in  health  but  absent  when  the 
splanchnic  vaso-motor  mechanism  is  defective. 

The  splanchnic  circulation  is  partly  venous  and  partly 
arterial,  and  consists  of  the  portal  vein  and  its  branches  and 
the  arterial  branches  of  the  celiac  axis.  When  a  person 
stands,  the  splanchnic  vaso-motor  mechanism  causes  a 
constriction  of  the  splanchnic  vessels  and  the  blood -pressure 
rises,  but,  if  ineffective,  it  fails  to  rise  or  falls.  Now,  in 
splanchnic  neurasthenia,  the  splanchnic  vaso-motor  mech- 
anism is  exhausted  and  it  is  inadequate  to  prevent  a  flow 
of  blood  to  the  splanchnic  vessels.  The  following  test 
demonstrates  an  adequate  automatism  of  the  vaso-motor 
mechanism : 

PULSE-RATE.  SYSTOLIC   BLOOD-PRESSURE. 

Lying 60  118 

Standing 60  130 

Difference o  — 12  mm. 

In  the  following  test,  the  vaso-motor  mechanism  is 
insufficient : 

PULSE-RATE.  SYSTOLIC  BLOOD-PRESSURE. 

Lying 60  104 

Standing 100  90 

Difference  .  .  . . — 40  — 14  mm. 

The  intraabdominal  venous  congestion  in  splanchnic 
neurasthenia  is  influenced  in  a  variety  of  ways: 

1.  By  abdominal  massage  and  abdominal  exercises. 

2.  By  strengthening  the  abdominal  muscles  (page  146). 

3.  By  abdominal  supporters. 

4.  By  eliciting  the  liver  reflex  of  contraction  (page  331). 

5.  By  toning  the  splanchnic  vaso-motor  mechanism. 

348 


G    I   e    n    a    r   d       s      Disease 

Respecting  the  latter  method.  The  dorsal  region  of  the 
spinal  cord  represents  the  origin  of  the  majority  of  vaso- 
constrictors in  the  body.  The  splanchnic  vaso -motor 
mechanism  which  controls  the  vessels  of  the  abdominal 
viscera  consists  of  the  splanchnic  nerves  which  are  composed 
of  fibers  issuing  from  the  cord  in  the  5th  to  the  i2th  dorsal 
nerves,  inclusive.  Reference  to  Fig.  10,  shows  that  the 
dorsal  nerves  in  question  correspond  to  the  spines  of  the  2nd 
to  the  8th  dorsal  vertebrae  inclusive. 

Now,  if  the  spines  in  question  are  sinusoidalized,  or  better 
still,  concussed,  the  cardio-splanchnic  phenomenon  (page 
346)  is  at  once  brought  into  evidence.  In  other  words,  the 
blood  is  expressed  from  the  abdominal  vessels  to  the  right 
heart. 

Concussion  then,  of  the  2nd  to  the  8th  dorsal  spines, 
inclusive,  is  a  very  active  means  of  augmenting  the  tone  of 
the  splanchnic  vaso-motor  mechanism  and  constitutes  a 
very  efficient  method  of  treatment  in  splanchnic  neurasthenia 
and  in  all  forms  of  intraabdominal  congestion  even  without 
nervous  symptoms. 

In  GlenarcFs  disease,  or  enteroptosis,  the  prolapse  of  one 
or  more  abdominal  organs  is  associated  with  neurasthenic 
symptoms  and  the  wearing  of  an  abdominal  supporter 
affords  much  relief  to  the  wearer.  The  relief  thus  attained 
is  not  due  wholly  to  reposition  of  the  organs,  as  is  instanced 
in  the  observations  of  Bial.  The  latter  applied  transparent 
bandages  to  cases  of  gastroptosis  and  transilluminated  the 
stomachs  before  and  after  the  application  of  the  bandages. 
No  change  in  the  position  of  the  stomach  could  be  noted, 
and  it  is  therefore  most  likely  that  abdominal  supporters  act 
chiefly  by  compression  of  the  viscera,  which,  in  turn,  squeeze 
the  blood  out  of  the  turgid  abdominal  veins. 

The  author  has  treated  many  cases  of  Glenard's  disease 

34* 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

based  on  the  principle  that  the  symptoms  are  often  dependent 
on  a  faulty  vaso-motor  mechanism  and  by  increasing  the 
tone  of  the  latter,  by  sinusoidalization  or  concussion  of  the 
spines  of  the  2nd  to  the  8th  dorsal  vertebra,  one  may 
ameliorate  the  symptoms. 


350 


The         Spleen 


CHAPTER  X. 

MISCELLANEOUS  REFLEXES. 

THE  SPLEEN — REFLEXES  OF  THE  SPLEEN — SPLENIC  REFLEXES  IN 
TREATMENT — UTERUS  REFLEX — DYSMENORRHEA — THE  BLADDER 
REFLEX — THE  KIDNEY  REFLEXES — NERVOUS  SYMPTOMS;  PAR- 
ALYSIS, CONTRACTURES,  ATAXIA. 

THE  SPLEEN. 

IS  enigmatical  organ  of  the  physiologist,  like  the  other 
viscera,  is  not  constant  in  size;  on  the  contrary,  the  spleen 
contracts  and  expands  synchronously  with  the  periods  of 
digestion.  It  attains  its  maximum  dimensions  at  about  the 
fifth  hour  after  a  meal  and  then  slowly  returns  to  its  previous 
size.  According  to  Schaefer,  motor  nerve-fibers  are  con- 
tained in  the  splanchnic  nerves  which,  when  stimulated, 
cause  either  a  contraction  or  a  dilatation  of  the  spleen.  No 
doubt  the  con  traction  and  dilatation  of  the  organ  aredependent 
on  its  intrinsic  musculature,  that  is,  the  plain  muscle  tissue 
existing  in  the  capsule  and  the  trabeculae.  It  has  been 
found  that  when  the  spleen  contracts  the  liver  becomes 
enlarged.  It  is  the  popular  belief  that  the  spleen  is  influenced 
by  the  nervous  system  and  Botkin  found  that  depressing 
emotions  increased  its  size  and  exhilarating  ideas  diminished 
it. 

The  latter  observer  also  noted  that  the  application  of 
the  induced  current  to  the  skin  over  the  spleen  in  a  case 
of  leukemia  caused  the  organ  to  contract  and  that  each  stim- 
ulation was  followed  by  an  increase  in  the  number  of  color- 
less corpuscles  in  the  blood  and  the  condition  of  the  patient 
improved.  We  will  note  presently  that  the  spleen  may  be 
made  to  contract  even  in  the  norm, 


Spondyloth     e     r    a   p    y 

In  fevers  there  is  an  acute  swelling  of  the  spleen  and  a 
chronic  enlargement  of  the  viscus  is  observed  in  malaria 
and  leukemia.  Enlargement  of  the  organ  (splenomegaly} 
is  associated  with  other  diseases  of  the  blood,  notably 
pernicious  anemia,  Hodgkin's  disease,  congenital  syphilis 
and  Band's  disease. 

REFLEXES  OF  THE  SPLEEN. 

Like  the  other  viscera,  two  reflexes  of  the  spleen  may  be 
elicited,  viz.,  that  of  contraction  and  dilatation. 

For  diagnostic  purposes  these  reflexes,  like  other  visceral 
reflexes,  are  obtained  by  several  concussion  blows  with  the 
hammer  on  a  pleximeter  while  the  latter  is  resting  on 
definite  vertebral  spines.  The  splenic  reflex  of  contraction 
is  elicited  by  concussing  in  succession  the  spines  of  the  first 
three  lumbar  vertebrae,  whereas  the  splenic  reflex  of  dilatation 
is  obtained  by  concussing  the  spine  of  the  nth  dorsal 
vertebra.  The  spleen  may  be  brought  into  evidence  by  this 
reflex  even  when  percussion  shows  no  area  of  splenic  dullness. 

The  contraction  and  dilatation  of  the  organ  are  evidenced 
by  percussion  and  to  aid  the  latter,  the  vibrations  of  the 
spine  and  sternum  may  be  suppressed  after  the  manner 
detailed  on  page  80. 

The  results  of  the  concussional  manceuvers  just  cited 
are  shown  in  Fig.  90. 

THE  SPLENIC  REFLEX  IN  TREATMENT. 

Only  the  splenic  reflex  of  contraction  has  thus  far  been 
employed  by  the  author  for  therapeutic  purposes,  although 
he  believes  that  careful  hematologic  examinations  after 
eliciting  both  reflexes,  may  shed  some  light  on  the  functions 
of  the  spleen  which  have  thus  far  baffled  physiological  investi- 
gations. 

352 


Splenic        Reflex 


FIG.  90. — Illustrating  the  splenic  reflexes.  The  continuous  line  represents  the 
area  of  dullness  of  the  spleen  before  vertebral  manipulation.  The  interrupted  line 
within  the  continuous  line  represents  the  splenic  reflex  of  contraction  whereas 
the  interrupted  line  outside  of  the  continuous  line  represents  the  splenic  reflex  of 
dilatation.  The  latter  reflex  measures  9  cm.  and  the  reflex  of  contraction  only 
3  cm.  in  the  anterior  axillary  line. 


353 


S    p     ondylotherapy 

The  fact  that  the  spleen  is  endowed  with  contractility 
has  engendered  the  employment  of  therapeutic  measures  to 
the  splenic  region  like  electricity  and  heat  and  cold  with 
the  object  of  reducing  the  volume  of  the  organ.  Such 
measures  are,  however,  only  illusory,  insomuch  as  any 
irritation  of  the  skin  in  the  region  of  the  spleen  produces 
a  dilatation  of  the  lungs  (lung  reflex  of  dilatation,  page  294) 
which,  descending  over  the  spleen,  gives  the  erroneous 
impression  that  the  spleen  has  contracted. 

It  was  the  erroneous  observation  of  Adamo  Moscucci 
that  led  the  author  to  first  discover  the  lung  reflex  of  dilatation. 
Moscucci  reported  the  cure  of  enlarged  spleens  in  malaria 
by  spraying  ether  over  the  splenic  region.  In  attempting  to 
confirm  the  observations  of  Moscucci,  the  author  found 
that  the  ether  acted  as  a  cutaneous  irritant  and  by  dilating 
the  lungs  gave  the  impression  that  there  was  a  reduction  in 
the  volume  of  the  spleen. 

The  anatomic  structure  of  the  spleen  suggests  its  function, 
viz.,  a  lymph-gland  which  acts  as  a  receptaculum  for  foreign 
and  noxious  elements  circulating  in  the  blood.  No  doubt 
the  leukocytes  in  the  spleen  assist  by  their  phagocytic  action 
in  destroying  the  noxious  elements  which  have  been  filtered 
by  the  organ.  Weidenreich  has  shown  that  the  splenic 
vein  contains  seventy  times  as  many  leukocytes  as  the 
splenic  artery. 

The  spleen  is  a  favorite  repository  for  microorganisms  and 
it  has  long  been  recognized  as  the  habitat  of  the  plasmodium 
malariae.  Indeed,  Laveran  avers  that  the  plasmodium  here 
finds  protection  from  destruction  in  the  circulation. 

The  fact  has  been  recognized  that  cutaneous  irritants 
(douches,  electricity,  etc.)  in  the  splenic  region  may  precipi- 
tate a  malarial  paroxysm  in  latent  malaria.  Here  it  is 
assumed,  that  the  therapeutic  manceuvers  in  question 

354 


Splenic         Reflexes 

contract  the  spleen  and  thus  dislodge  mechanically  into  the 
circulation  the  plasmodia  which  have  lodged  in  the  organ. 
Quinin  has  a  specific  action  on  smooth  muscle  and  contrac- 
tions of  the  spleen,  uterus  and  intestines  have  been  observed. 

Now,  quinin  in  its  action  shows  a  specific  toxicity  to  the 
organisms  of  malaria,  yet  even  when  the  plasmodia  cannot 
be  demonstrated  in  the  blood  of  the  periphery,  a  single  dose 
of  quinin  by  contracting  the  spleen  may  force  the  plasmodia 
into  the  circulation  and  thus  make  their  demonstration 
evident. 

Samuel  Hahnemann's  homeopathic  theory  of  similia 
similibus  curantur  was  founded  on  this  untoward  effect  of 
quinin.  Hahnemann,  at  one  time,  had  malaria,  and  suffered 
from  no  attack  for  many  years,  until  one  day  he  tried  the 
effect  of  cinchona  upon  himself  for  experimental  purposes. 
The  ingestion  of  the  drug  was  followed  by  a  violent  rigor 
and  a  well-marked  attack  of  ague,  and  thus  he  argued :  If 
cinchona  is  a  remedy  for  ague,  and  if  in  me  it  has  precipi- 
tated an  attack  of  the  disease,  it  must  follow  that  a  small 
dose  of  the  drug  which  produces  certain  symptoms  will  cure 
the  same  symptoms  when  they  are  caused  by  the  disease. 

The  author  has  shown  that  the  splenic  reflex  of  con- 
traction may  be  elicited  most  effectually  by  concussion  of 
the  first  three  lumbar  spines  and  he  has  utilized  this  reflex 
in  the  diagnosis  and  treatment  of  malaria.  Thus,  in  latent 
malaria,  he  has  precipitated  a  typic  paroxysm  (chill,  fever 
and  sweating)  by  such  concussion.  He  has  also  demon- 
strated after  the  latter  manoeuver  the  presence  of  plasmodia 
in  the  blood,  although  absent  previous  to  the  concussion. 

In  the  treatment  of  malaria,  he  employs  concussion  in 
connection  with  the  use  of  quinin  and,  in  this  way,  he  has 
achieved  excellent  results. 

Several  cases  of  pernicious  malaria  and  malarial  cachexia 

355 


Spondylotherapy 

are  recalled  which  resisted  the  action  of  quinin  alone,  but 
when  the  latter  was  used  in  combination  with  concussion, 
treatment  was  effective. 

It  may  also  be  observed  that  although  in  these  cases, 
months  and  even  years  may  elapse  before  there  is  any 
reduction  in  the  size  of  the  spleen,  concussion  of  the  spines 
of  the  first  three  lumbar  vertebrae  will  cause  the  ague-cake 
to  disappear  after  several  weeks  treatment. 

Puncture  of  the  spleen  has  often  been  done  with  the  object 
of  aspirating  the  juice  of  the  spleen  to  demonstrate  in  the 
latter,  the  plasmodia  and  typhoid  bacilli.  The  latter  are 
almost  constantly  found  in  the  spleen.  Splenic -puncture  is 
by  no  means  a  harmless  procedure  and,  for  this  reason,  it 
has  been  abandoned  by  conservative  clinicians. 

Isolation  of  typhoid  bacilli  from  the  blood  is  a  useful 
procedure  in  the  diagnosis  of  typhoid  fever,  and  the  author 
suggests  concussion  of  the  lumbar  spines  to  facilitate  the 
demonstration  of  the  bacilli  in  the  blood.  He  has  had, 
however,  no  proof  to  justify  the  suggestion. 

The  following  cases  are  interesting: 

I.  A   young    man    had    symptoms    suggesting  the 
latent  or  ambulatory  form  of  typhoid  fever.    The  spines 
of  the  first  three  lumbar  vertebrae  were  concussed  during 
a  seance  lasting  ten  minutes.     The  following  day,  the 
typic  symptoms  of  typhoid  fever  appeared  and  conva- 
lescence was  not  established  until  the  fiftieth  day. 

One  could,  with  reason,  regard  the  development  of 
the  symptoms  following  concussion  as  a  mere  coinci- 
dence, yet  a  like  observation  in  two  other  cases  of  a 
similar  nature  would  seem  to  justify  the  conclusion  that, 
in  consequence  of  contraction  of  the  spleen  following 
the  manoeuver,  typhoid  bacilli  were  forced  into  the 
general  circulation  by  contraction  of  the  spleen. 

II.  A  young  lady  had  apyrexia  for  one  month  fol- 

356 


Splenic        Reflexes 

lowing  typhoid  fever.  Her  spleen  was  enlarged  and  she 
suffered  pain  (as  often  occurs  from  tension  of  the  capsule 
of  the  spleen)  in  the  region  of  the  organ.  An  effort  was 
made  to  reduce  the  volume  of  the  organ  by  concussion  of 
the  spines  of  the  first  three  lumbar  vertebrae.  After 
three  treatments,  she  suffered  a  relapse  lasting  fifteen 
days  and  roseola,  diarrhoea  and  a  step-like  temperature 
were  prominent  symptoms, 

The  conditions  favoring  a  relapse  in  typhoid  fever  are 
unknown.  A  relapse  is  associated  very  often  with  some 
indiscretion  in  diet. 

The  author  supposes  that  in  these  cases  reinfection 
results  from  contraction  of  the  spleen  forcing  the  typhoid 
bacilli  into  the  circulation.  Indiscretions  in  diet  are  followed 
by  an  enlargement  with  subsequent  contraction  of  the  spleen. 
For  this  reason,  the  author  suggests  concussion  as  a  thera- 
peutic manceuver  not  only  to  prevent  relapses  but  to  hasten 
defervescence  in  typhoid  fever. 

This  same  therapeutic  manceuver  suggests  itself  in  the 
treatment  and  diagnosis  of  other  infectious  diseases  associated 
with  an  enlargement  of  the  spleen. 

It  has  been  known  for  some  time  that  enlargement  of 
the  spleen  was  associated  with  anemia  and  cachexia,  and 
the  condition  was  specified  as  splenic  anemia  or  splenomegalia 
cum  anemia,  but  Banti  demonstrated  that  the  splenomegaly 
was  not  secondary  as  in  leukemia,  but  autochthonous  and 
responsible  for  the  symptomatic  complex  known  as  Banti's 
disease. 

The  author  has  successfully  treated  one  case  of  the  latter 
disease  by  elicitation  of  the  splenic  reflex  of  contraction  after 
a  number  of  seances  of  concussion  of  the  spines  of  the  three 
first  lumbar  vertebrae. 


357 


S   p    o     n    d    y    I    o    t    h     e    r    a    p    y 


THE  UTERUS  REFLEX. 

If  one  electrode  from  a  sinusoidal  current  is  applied 
over  the  sacrum  and  an  interrupting  electrode  is  fixed  over 
the  spines  of  any  of  the  first  three  lumbar  vertebrae,  a  distinct 
contraction  of  the  uterine  walls  may  be  observed  through  a 
speculum.  The  author  has  had  no  experience  with  this 
reflex  in  treatment  and  is  therefore  unable  to  determine  its 
practical  value. 

DYSMENORRHEA. 

Painful  menstruation  is  subdued  in  conventional  practice 
by  treatment  of  the  cause  and  the  use  of  some  analgesic 
during  the  paroxysm  of  pain.  The  author  has  thus  far 
examined  about  fifty  patients  who  suffer  from  painful  men- 
struation and  has  noted  points  of  tenderness  located  either 
to  the  right  or  left  side  or  both  sides  of  one  or  more  of  the 
spines  of  the  first  four  lumbar  vertebrae.  Firm  pressure 
made  with  the  end  of  the  thumb  (page  170)  over  one  or 
more  sensitive  areas  will  abolish  the  pain  for  several  hours 
or  during  the  entire  period  of  the  menstruation.  The 
latter  excellent  result,  however,  is  infrequently  achieved, 
and  it  may  be  necessary  to  repeat  the  manceuver  several 
times  during  the  menstrual  period.  The  areas  of  tenderness 
may  be  marked  with  a  stick  of  nitrate  of  silver  and  some 
member  of  the  family  may  be  taught  the  method  of  making 
pressure.  In  other  instances  the  areas  of  tenderness  may  be 
frozen  (page  172)  and  the  effect  may  last  during  the  entire 
menstrual  period.  Freezing,  if  effective,  is  decidedly  more 
lasting  in  its  results  than  pressure. 

THE  BLADDER  REFLEX. 

The  author  has  investigated  this  reflex  in  association 
with  Dr.  Henry  Meyer  of  San  Francisco,  an  acknowledged 

358 


Kidney        Reflexes 

expert  with  the  cystoscope.  With  one  electrode  over  the 
sacrum  and  the  interrupting  electrode  at  the  spine  of  the 
5th  lumbar  vertebra,  a  decided  contraction  of  the  wall  of 
the  bladder  and  its  sphincter  can  be  observed  with  the 
cystoscope.  The  sinusoidal  current  was  used  and  contraction 
of  the  abdominal  wall  was  excluded.  No  doubt  there  is  a 
distinct  vertebral  site  for  contraction  of  the  sphincter  and 
for  the  detrusor  vesicae.  However,  the  reflex  in  question  is 
merely  cited  as  a  suggestion  to  cystoscopists  for  its  elabora- 
tion. The  bladder  reflex  may  be  utilized  in  atonic  conditions 
of  the  musculature  of  the  bladder. 

THE  KIDNEY  REFLEXES. 
PERCUSSION  OF  THE  KIDNEYS. 

Among  the  cognate  branches  of  medicine,  physical 
diagnosis  is  the  least  progressive.  It  still  bears  the  imprint 
of  tradition  and  any  attempt  to  improve  upon  the  methods 
of  the  founders — Auenbrugger,  Laennec,  Skoda  and  others — 
is  viewed  as  an  act  of  sacrilege.  It  is  suggested  in  the  text- 
books, that  owing  to  the  anatomic  position  of  the  kidneys 
(Fig.  n),  their  boundaries  cannot  be  limited  by  percussion 
and  that  the  thick  layers  of  muscles  behind  yield  a  dullness 
which  an  organ  as  thin  as  the  kidney  could  not  increase. 
It  may  be  affirmed,  however,  that,  as  a  rule  (excluding 
non -resonant  impacted  feces  in  the  colon),  one  may  deter- 
mine the  lower  and  a  portion  of  the  outer  border  of  each 
kidney  by  contrasting  its  dullness  with  the  tympanicity  of 
the  ascending  and  descending  colon  which  lie  anterior  to 
each  organ.  If  it  is  a  question  of  tympanicity  which  obscures 
the  dullness  of  the  kidney,  this  objectionable  feature  may 
be  obviated  by  suppressing  the  vibrations  of  the  spine  by 
having  an  assistant  fix  his  hand  on  the  latter  during  per- 
cussion (vide  vibro-suppression).  If  it  is  a  question  of 

359 


S  p     o     n     d    y    I    o     the     r    a    p    y 

dullness  of  the  spinal  muscles,  have  the  patient  lean  far 
backward  to  relax  the  muscles  during  percussion.  Having 
defined  the  kidneys  by  percussion,  concuss  in  succession 
with  the  hammer  and  pleximeter  (Fig.  2),  the  6th,  yth  and 
8th  dorsal  spines ;  percussion  executed  at  once  now  demon - 


FIG.  91. — Kidney  reflexes  of  contraction  and  dilatation.  The  continuous 
line  represents  the  area  of  kidney-dullness  and  the  dotted  lines  within  and  without 
the  reflexes  of  contraction  and  dilatation  respectively. 

strates  an  increase  in  the  area  of  renal  dullness  which  is  the 
kidney  reflex  of  dilatation.  Concussion  of  the  i2th  dorsal 
vertebral  spine  causes  a  decrease  in  the  area  of  renal  dull- 
ness, which  is  the  kidney  reflex  of  contraction  (Fig.  91). 
The  latter,  like  other  visceral  reflexes,  are  of  limited  duration. 
It  is  known  that  by  means  of  the  oncometer,  that  the  kidney, 
like  the  spleen,  shows  variations  in  volume.  The  real 
volume  of  the  living  kidney  depends  upon  the  distension  of 

360 


Kidney         Reflexes 

its  structural  elements,  upon  the  quantity  of  lymph  and 
specially  upon  the  amount  of  blood  in  its  blood-vessels. 
When  the  latter  dilate  the  kidney  increases  in  size  and 
when  the  vessels  contract,  the  kindey  diminishes  in  volume. 

THE    KIDNEY    REFLEXES     IN    DIAGNOSIS     AND     TREATMENT. 

Insomuch  as  the  kidney  reflexes  have  only  recently  been 
discovered  by  the  author,  anything  he  may  say  concerning 
their  value  in  diagnosis  and  treatment  can  only  be  theoretic. 
One  could  assume  that  backache  due  to  distension  of  the 
capsule  of  the  kidney  could  be  relieved  by  diminishing  the 
volume  of  the  organ  by  concussing  the  i2th  dorsal  spine 
with  the  hammer.  Pain  due  to  the  presence  of  a  renal 
calculus  would  be  intensified  by  the  same  manoeuver. 

A  dull  area  supposed  to  be  the  kidney  would  increase  with 
elicitation  of  the  kidney  reflex  of  dilatation  and  would 
decrease  by  elicitation  of  the  counter  kidney  reflex.  Surgery 
has  been  invoked  in  the  treatment  of  chronic  nephritis. 

Thus,  some  surgeons  have  resorted  to  puncture  (reni- 
puncture)  of  the  kidney  and  others  to  incision  of  the  capsule, 
thus  assuming  that  the  fundamental  condition  demanding 
relief  was  tension  of  the  organ.  Others  assume  that  nephro- 
pexy  relieves  the  condition  by  establishing  vascular  adhesions 
which  carry  an  additional  supply  of  blood. 

The  author  has  treated  only  one  case  of  parenchymatous 
nephritis  by  concussion,  but  the  results  are  nevertheless 
interesting.  Acting  upon  the  theory  that  a  better  blood - 
supply  was  essential,  the  treatment  consisted  of  daily  seances 
of  concussion  to  elicit  the  kidney  reflex  of  dilatation.  After 
about  seven  treatments,  the  albumin  increased  in  the  urine, 
the  blood -pressure  became  higher  and  edema  of  the  ex- 
tremities developed.  Concussion  of  the  spine  of  the  i2th 
dorsal  vertebra  was  then  executed  to  elicit  the  reflex  of 

361 


Spondylotherapy 

contraction  and  thus  diminish  the  volume  of  the  kidney. 
After  a  few  treatments  the  edema  rapidly  disappeared,  the 
blood -pressure  sank  to  165  mm.  (from  210  mm.)  but  the 
albumin  continued  in  the  urine  (at  this  time  of  writing), 
although  slightly  diminished  in  percentage. 

In  interstitial  nephritis,  increasing  the  volume  of  the 
kidney  (by  eliciting  the  kidney  reflex  of  dilatation)  would 
theoretically  be  indicated. 

NERVOUS  SYMPTOMS. 
PARALYSIS. 

Reference  has  already  been  made  on  page  n  to  the 
spinal  muscular  reflexes. 

In  electrotherapeutics,  the  average  neurologist  concerns 
himself  with  the  employment  of  only  the  Galvanic  and 
Faradic  currents.  He  has  little  faith  in  influencing  the  site 
of  the  lesion  and  contents  himself  with  stimulation  of  the 
paralyzed  muscles,  hoping  that  such  irritation  may  act  in- 
directly at  the  site  of  the  lesion. 

Reference  has  already  been  made  to  the  action  of  the 
sinusoidal  current  on  page  n,  in  provoking  contraction  of 
the  muscles  by  central  stimulation.  Other  currents  are  not 
effective  in  achieving  this  object.  By  vertebral  stimulation, 
one  may  provoke  contractions  of  muscles  which  are  not 
possible  by  the  conventional  method  of  peripheral  applica- 
tion. The  contractions  of  the  muscles  are  bilateral,  and  the 
latter  fact  is  of  great  importance  in  comparing  the  contrac- 
tions on  both  sides  of  the  body.  The  illustration  on  page  13 
will  aid  the  physician  in  contracting  definite  groups  of 
muscles.  Thus,  as  an  example,  one  may  cite  the  following: 
Assuming  that  the  patient  cannot  extend  the  leg  upon  the 
thigh.  Here  the  quadriceps  femoris  is  implicated.  Reference 
to  Fig.  14  shows  that  the  cell-bodies  of  origin  of  the  quad- 
riceps femoris  are  located  in  the  2nd  and  3rd  lumbar  seg- 

362 


Contractures    and    Ataxia 

ments  of  the  cord  and  that  these  segments  correspond  to 
the  loth  dorsal  spinous  process  (page  14  and  Fig.  10).  To 
stimulate  the  muscle  in  question  the  exciting  pole,  i.  e.,  the 
interrupting  electrode  of  the  sinusoidal  current  is  fixed  at 
the  spinous  process  of  the  loth  dorsal  vertebra,  whereas 
the  indifferent  electrode  is  placed  over  the  sacrum. 

CONTRACTURES. 

When  definite  groups  of  muscles  are  weakened  or  para- 
lyzed, the  antagonistic  muscles  not  encountering  the  normal 
resistance  to  their  action,  move  the  limb  in  an  abnormal 
position  and  hold  it  there.  The  latter  is  a  passive  contracture. 
If  a  limb  is  fixed  in  an  abnormal  position  by  a  tonic  con- 
traction of  certain  groups  of  muscles,  one  is  dealing  with  an 
active  or  spastic  contracture.  Concerning  the  reciprocal 
action  of  antagonistic  muscles,  the  researches  of  Sherrington 
show  in  brief  that  the  inhibition  of  the  tonus  of  a  voluntary 
muscle  may  be  brought  about  by  the  excitation  of  its  an- 
tagonist. To  overcome  contractures,  vertebral  sinusoidali- 
zation  is  very  effective  in  stimulating  groups  of  muscles 
antagonistic  to  the  shortened  muscles  after  the  method  of 
segmental  localization  just  described  under  paralysis.* 

ATAXIA. 

The  attention  of  the  reader  is  directed  to  the  remarks 
on  page  28,  concerning  the  knee-jerk  in  locomotor  ataxia. 
It  is  generally  conceded  that  in  the  latter  affection  the  ataxia 
is  caused  either  by  a  loss  or  disturbance  of  the  afferent 
impulses  from  the  deep  tissues,  joints  and  muscles.  In 
addition  there  is  a  disturbance  of  the  muscular  sense  and 
hypotonia  (q.  v.)  is  present. 

Attention  has  already  been  directed  on  page  165  to  the 
re-education  of  co-ordinated  movements  in  locomotor  ataxia 

*For  further  reference  to  this  method  of  treatment,  vide  footnote  on  page  147. 

363 


S    p     o     n     d    y    I    o     t    h     e     r    a   p    y 

which  has  yielded  excellent  results.  The  re-education 
method  is  based  on  the  observation  that  if  an  ataxic  indi- 
vidual repeats  a  movement  several  times  in  succession,  the 
ataxia  in  such  a  movement  becomes  less  evident.  The 
tabetic  patient  has  an  erroneous  idea  of  the  movement  which 
he  is  executing,  with  the  consequence  that  the  movement 
is  faulty.  The  "movement-memories"  which  he  had  in 
health  no  longer  subserve  his  purpose  and  a  new  series  of 
"movement-memories"  must  be  acquired  corresponding  to 
the  impressions  which  are  received  through  neurons  which 
are  still  intact. 

The  author  has  shown  that  whereas  the  afferent  paths 
are  compromised,  the  descending  or  motor  paths  may  not 
be  impaired.  Taking  advantage  of  the  latter  fact  he  effects 
re-education  of  the  defective  movements  by  vertebral 
sinusoidalization  with  results  which  prompt  him  to  say 
supersede  the  conventional  exercises  in  rapidity  of  action. 
The  method,  in  brief,  is  to  bring  into  action  definite  muscle- 
groups  of  the  lower  extremities  by  applying  one  large 
electrode  to  the  region  of  the  sacrum  and  the  interrupting 
electrode  over  definite  spinous  processes  (page  13).  The 
author  cautions  against  the  employment  of  a  strong  sinu- 
soidal current.  The  latter  should  only  be  sufficiently  strong 
to  provoke  slight  contractions  of  the  muscles ;  otherwise,  a 
hypertonicity  of  certain  muscles  ensues,  resulting  in  muscle  - 
bound  extremities  making  locomotion  even  more  difficult 
than  before  the  use  of  the  current  in  question.  Not  infre- 
quently, the  large  electrode  may  be  fixed  in  the  lower  dorsal 
region,  and  the  interrupting  electrode  over  definite  spinous 
processes.  One  of  my  ataxic  patients  had  difficulty  in  loco- 
motion owing  to  abduction  of  the  lower  extremity.  By  bring- 
ing the  adductors  into  play  by  vertebral  sinusoidalization  the 
difficulty  was  corrected.  The  relief  of  PAIN  in  locomotor  ataxia 
may  be  attained  by  the  methods  suggested  in  chapter  XI. 


Therapeutics      of     Pain 
CHAPTER  XI. 

THE  THERAPEUTICS  AND  DIAGNOSIS  OF  PAIN. 

SEGMENTAL-ANALGESIA  —  CONCUSSION-ANALGESIA  —  SEGMENTAL-LO- 
CALIZATION — THE  TRIGEMINUS  NERVE — SINUSOIDAL-ANALGESIA — 
SEGMENTAL-PSYCHROTHERAPY — SEGMENTAL-ANALGESIA  OF  THE 
VISCERA — SEGMENTAL-ANALGESIA  IN  DIAGNOSIS — PHYSIOLOGY  OF 
SPONDYLOTHERAPEUTIC  METHODS. — SPINAL  NERVE-TRUNK  ANAL- 
GESIA— CORTICAL  SINUSOIDALIZATION. 

'HpHE  pharmacotherapy  of  pain  concerns  itself  with  the 
•*•  use  of  drugs  known  as  anodynes  or  analgesics  which 
annihilate  sensation  either  through  the  brain  (opium  and 
its  derivatives)  or  by  enfeebling  the  heart,  which  relieves 
the  hyperemic  pressure  on  the  nerve -tissues. 

LOCAL  ANESTHESIA  is  effected  by  cocain  and  its  substi- 
tutes. Aconite  primarily  causes  local  irritation  followed  by 
anesthesia,  but  it  produces  no  inflammation  of  the  part. 

Among  the  aromatic  series,  carbolic  acid  is  the  most 
important  local  anesthetic.  By  applying  a  drop  of  the  acid 
to  the  skin,  one  is  able  to  puncture  the  latter  without  pain. 
Among  the  mechanic  methods  are :  protracted  tepid  baths, 
freezing,  cupping  and  counterirritation. 

In  the  treatment  of  pain  by  methods  other  than  drug- 
giving,  it  is  customary  to  employ  agents  at  the  peripheral 
site  of  the  pain,  thus  ignoring  the  "law  of  eccentric  projection" 
viz.,  in  stimulation  of  a  nerve,  irrespective  upon  which  point 
of  the  course  of  the  nerve  it  acts,  the  perception  of  a  pain 
is  transferred  to  the  periphery.  Pain  perception  results 
from  an  accumulation  of  individual  stimulations  in  the  gray 
substance  of  the  spinal  cord.  Thus,  in 'the  employment  of 
our  peripheric  methods,  we  usually  disregard  the  true  origin 

365 


Spondyloth     e    r    a    p    y 

of  the  pain.    That  the  average  physician  ignores  the  central 
origin  of  pain  may  be  exemplified  by  the  following  case : 

A  middle-aged  individual  suffered  for  four  years 
from  a  brachial  neuritis.  The  pains  were  so  violent 
that  morphin  was  habitually  used;  in  fact,  his  last 
physician  instructed  him  how  to  use  the  hypodermic 
syringe.  Ever  since  his  trouble  commenced  he  has  trav- 
eled from  city  to  city  seeking  relief.  Every  conceivable 
method  known  in  physiotherapy  was  employed,  but 
always  at  the  peripheral  site  of  the  pain.  An  examination 
revealed  a  few  points  of  vertebral  tenderness  at  the  exits 
of  some  of  the  spinal  nerves,  whereas  others  were  de- 
veloped as  a  result  of  manipulation  of  the  peripheral 
areas  of  tenderness.  The  paravertebral  area  of  vertebral 
tenderness  was  frozen  most  thoroughly  and  for  the  first 
time  in  four  years  the  patient  had  a  surcease  of 
his  pain  for  about  eight  hours.  A  second  freezing  gave 
relief  for  two  days,  and  a  few  further  freezings  sufficed 
for  a  cure.* 

SEGMENTAL -ANALGESIA. 

Under  this  caption  the  author  refers  to  the  annihilation 
of  pain  in  skin-areas  and  viscera  related  to  different  spinal- 
segments.  Cutaneous  and  visceral  analgesia  may  be  achieved 
by  the  following  methods : 

1.  Concussion. 

2.  Slow  sinusoidal  current. 

3.  Freezing. 

4.  Pressure  (vide  page  170). 

Other  remedial  measures  (such  as  the  high  frequency 
current,  rapid  sinusoidal  current,  Galvanic  and  Faradic 

*A11  cases  of  neuritis  are  not  equally  amenable  to  such  rapid  results,  and 
it  may  be  necessary  to  freeze  the  sensitive  peripheral  nerves  as  a  palli- 
ative and  curative  measure,  insomuch  as  they  may  represent  the  site  of  a 
neuritic  process  and  not  as  is  usually  the  case,  at  the  points  of  exit  of  the 
spinal  nerves. 

366 


Concussion     -    Analgesia 

electricity,  phototherapy,  cupping  and  counterirritation) 
have  been  tried  with  the  same  object  in  view  but  without 
results. 

CONCUSSION-ANALGESIA. 

The  fear  of  employing  forcible  concussion  of  the  spinous 
processes  and  the  use  of  ineffectual  apparatus  have  deterred 
physicians  from  obtaining  more  definite  and  decided  results 
from  vibro -massage.  Reference  to  the  foregoing  facts  has 
already  been  made  on  page  178.  Here,  as  elsewhere  in  this 
work,  the  results  cited  have  been  achieved  by  the  pneumatic 
hammer,  but  any  other  apparatus  yielding  a  series  of  strong 
percussion  blows,  will  no  doubt  yield  like  results. 

Preliminarily,  the  following  facts  are  worthy  of  emphasis : 

1 .  Concussion  and  sinusoidalization  stimulate  the  motor 
component  of    a    spinal -segment  and  subdue  its  sensory 
constituent. 

2.  The  sensory  component  of  a  normal  spinal -segment 
is  less  amenable  to  concussion,  sinusoidalization  and  freezing 
than  a  hyperesthetic  segment. 

In  other  words,  concussion,  sinusoidalization  and  freezing 
show  a  more  decided  analgesic  action  on  hyperesthetic 
viscera  and  peripheral  areas  than  when  the  tissues  in  question 
are  normal.  In  the  employment  of  the  foregoing  methods, 
the  analgesia  is  bilateral. 

SEGMENTAL -LOCALIZATION. 

Reference  has  already  been  made  to  this  subject  on  page 
30.  Assuming  that  the  patient  has  pain  in  one  of  the  skin- 
areas  (Fig.  15),  it  is  not  difficult  to  ascertain  the  relation 
which  a  given  area  bears  to  a  spinous  process  by  con- 
sulting Fig.  10. 

Thus,  a  patient  suffers  from  pain  on  the  anterior  surface 
of  the  toes  (Fig.  15)  involving  the  second  sacral  segment. 

367 


8    p     ondyloth 


r    a   p    y 


FIG.  92. — Showing  skin-areas  corresponding  to  the  different  spinal-segments. 
The  numbers  refer  to  the  various  spinous  processes  which  are  related  to  the  seg- 
ments and  which,  when  concussed,  sinusoidalized  or  frozen,  cause  analgesia  in 
the  different  skin-areas.  C,  cervical;  D,  dorsal;  S,  sacral.  Thus  sDS  sig- 
nifies that  concussion,  sinusoidalization  or  freezing  of  the  region  corresponding 
to  the  fifth  dorsal  spine  will  render  the  skin-area  analgesic  related  to  the  8th  dorsa  1 
segment. 

FIG.  93. — Showing  skin-areas  on  the  posterior  surface  of  the  body  corresponding 
to  the  different  spinal-segments.  The  numbers  refer  to  the  various  spinous  proc- 
esses related  to  the  segments  of  the  cord. 

368 


Segmental     -     Localization 

Reference  to  Fig.  10,  shows  that  the  segment  in  question  is 
related  to  the  i2th  dorsal  spine.  The  author  has  simplified 
segmental -localization  in  Figs.  92  and  93. 

Assuming  that  a  patient  has  a  neuritis  in  the  region  of 
the  arm  corresponding  to  the  5th  cervical  segment  (C5,  Fig. 
92).  If  one  now  concusses  the  3rd  cervical  spine  (which  is 
related  to  this  segment),  the  spontaneous  pain  disappears 
and  analgesia  may  be  noted  objectively  in  05. 

Concussion  is  without  doubt  superior  to  slow  sinusoidal- 
ization  and  freezing  in  effecting  this  object. 

In  most  instances,  this  analgesic  effect  is  noted  after 
concussion  for  about  three  minutes,  although  a  longer  time 
may  be  necessary  to  effect  this  object.  The  duration  of  the 
analgesia,  i.  e.,  insensitiveness  to  the  prick  of  a  pin,  is  usually 
of  shorter  duration  than  the  relief  from  pain  experienced  by 
the  patient.  Although  the  pain-sense  is  abolished,  the  sense 
of  touch  may  be  intact. 

Another  example  may  be  cited  illustrating  the  importance 
of  segmental-analgesia.  A  patient  has  lumbago  and  the 
sensitiveness  of  his  skin  does  not  permit  of.  the  local  applica- 
tion of  a  sufficiently  strong  sinusoidal  current.  Note  that  the 
skin  of  the  lumbar  region  corresponds  approximately  to  the 
9th,  loth  and  nth  dorsal  segments,  which  in  turn  are  related 
to  the  5th,  6th  and  yth  dorsal  spines.  If  the  latter  spines 
are  now  concussed  for  several  minutes,  the  analgesia  of  the 
lumbar  region  permits  of  the  electric  application  equal  to  at 
least  three  times  its  original  strength. 

SEGMENTAL-LOCALIZATION   BY   THE   ELICITATION   OF   VERTE- 
BRAL TENDERNESS. 

This  subject  has  already  been  discussed  on  page  71.  In 
brief,  when  a  sensitive  peripheral  structure  is  subjected  to 
pressure  (e.  g,,  a  sensitive  nerve),  or  manipulated  (e.  g.,  a 

369 


S    p     o    n     d    y    I    o    t    h     e    r    a   p    y 

sensitive  joint),  within  a  minute  an  area  of  vertebral  tender- 
ness (corresponding  to  the  roots  of  the  spinal  nerves)  may 
be  elicited  by  deep  pressure  at  the  exits  of  the  nerve  or  nerves. 
This  area  of  paravertebral  tenderness  is  usually  of  short 
duration. 

To  locate  the  segment  of  the  cord  related  to  this  area, 
the  spinal  nerve  may  be  traced  to  its  segment  (Fig.  10),  or 
the  table  on  page  37  will  show  its  relation  to  the  spinous 
processes. 

The  fact  of  the  matter  is  that  the  author's  method  of 
concussion -analgesia  shows  that  the  skin-areas  ordinarily 
accepted  as  related  to  definite  spinal-segments  are  only 
partially  correct.  It  is,  for  the  latter  reason,  as  will  be 
discussed  later  (under  freezing),  that  segmental-localization 
by  the  elicitation  of  vertebral  tenderness  is  often  preferred. 

A  patient  has  an  inflammation  of  the  shoulder-joint 
(omarthritis)  with  adhesions.  It  is  necessary  in  conse- 
quence of  the  latter  to  give  relief  to  the  ankylosis  and 
pains,  but  owing  to  the  pain  consequent  upon  manipula- 
tion of  the  joint,  it  is  impossible  to  execute  sufficient 
force.  There  are  no  areas  of  vertebral  tenderness  until 
after  manipulation  of  the  joint  for  several  seconds,  when 
tender  points  may  be  detected  corresponding  to  the  2nd, 
3rd  and  4th  dorsal  spines.  The  spinal  nerves  which 
make  their  exit  at  these  points  correspond  approximately 
to  the  2nd,  3rd  and  4th  dorsal  segments.  Therefore, 
after  concussion  of  the  6th  and  yth  cervical  spines  and 
ist  dorsal  spine  for  about  three  minutes,  the  shoulder- 
joint  may  be  manipulated  with  almost  as  little  pain  as 
though  the  patient  were  under  the  influence  of  an 
anesthetic. 

From  a  therapeutic  standpoint,  it  may  be  argued  that 
the  relief  of  pain  secured  by  concussion  is  merely  palliative 
and  is  productive  of  no  better  results  than  from  the  employ- 

370 


Trigemin'us         Nerve 

ment  of  the  conventional  analgesics.  In  a  sense,  this  con- 
tention is  correct  for  the  author  has  had  recourse  to  con- 
cussion daily  or  even  twice  daily,  for  weeks  in  many  cases  of 
neuritis  and  other  painful  affections,  securing  thereby  only 
relief  from  pain. 

However,  in  some  chronic  painful  affections,  concussion 
was  almost  marvelous  after  several  applications  in  giving 
permanent  relief. 

Here  one  is  constrained  to  conclude  that  the  lesion  is 
not  peripheral,  but  central,  and  that  direct  spinal-concussion 
effects  some  intra-spinal  change  (vide  physiology  of  spon- 
dylo therapeutic  methods). 

SEGMENTAL  LOCALIZATION  OF  THE  PERIPHERAL  NERVES. 

Lesions  of  the  peripheral  nerves  yield  symptoms  quite 
distinct  from  those  of  the  spinal  cord  itself.  The  sensory 
symptoms  consist  essentially  of  numbness  and  tingling  in 
the  areas  related  to  the  peripheral  nerves  and  the  perception 
of  pain,  touch  and  temperature  are  usually  only  slightly 
impaired.  The  affected  nerve  is  very  sensitive  to  pressure 
and  points  douloureux  (page  185)  may  be  detected  along  the 
course  of  the  nerve.  The  peripheral  distribution  of  sensory 
nerves  (after  Bailey)  is  shown  in  Figs.  94  and  95,  and  by 
consulting  Fig.  10,  their  relation  to  the  spinal-segments 
may  be  determined.  The  latter  fact  is  of  importance  when 
it  is  desirous  of  annihilating  (by  concussion-analgesia)  pains 
of  the  nerves  in  question. 

THE  TRIGEMINUS  NERVE. 

Reference  to  Fig.  15  shows  that  only  a  small  part  of  the 
skin  of  the  head  and  face  is  supplied  by  the  cervical  spinal 
nerves.  The  sensory  division  of  the  trigeminus  supplies 

371 


Spondyloth 


r    a    p   y 


N.  trtgi 


Plexus  cervict ' '."'.', ' 
N.  supracfavic.- 

N.  axill. 

N.  cut.  medial  is*  — 


;->\-- N.  peron,  tufir, 

•      \V N.  suralis, 

N.  peron.  prof. 

FIG.  94. — Peripheral  distribution  of  sensory  nerves. 

372 


s 


n 


y      N 


V 


rf.  lig.  sacrq-tub, 


N.  eut.fott.  — 


R.  cut.  fat, 
N.  pcron, 

N.  .»//». 


N.  suralis. . 

N.  plant,  tat. 

N.  ;»/««/  »/<•<£, 

FIG.  95. — Peripheral  distribution  of  sensory  nerves. 


373 


Spondylotherapy 

the  skin  of  the  face,  the  mucosa  of  the  mouth  and  nasal 
cavities  and  the  cornea. 

The  author  has  endeavored  to  influence  the  sensory 
functions  of  the  trigeminus  by  concussion,  sinusoidalization 
and  freezing  over  the  site  corresponding  to  the  location  of 
the  Gasserian  ganglion  (Fig.  96),  from  the  sensory  cells  of 
which  the  sensory  root  of  the  trigeminus  arises.  The  results 
have  not  been  as  good  as  when  the  spinal  nerves  are  similarly 
influenced.  Here  freezing  (at  the  site  of  the  Gasserian  gan- 


FIG.  96. — The  trigeminus  or  5th  cranial  nerve  with  its  three  chief  branches 
arising  from  the  Gasserian  ganglion. 

glion)  and  sinusoidalization  are  more  effective  than  con- 
cussion.* 

SINUSOIDAL -ANALGESIA. 

The  sinusoidal  current  is  less  effective  than  concussion 
in  producing  segmental-analgesia.  Only  the  slow  sinusoidal 
current  is  effective  for  this  purpose  and  it  is  obtained  from 
the  Victor  multiplex  sinusoidal  outfit.  The  current  bombards 
the  segment  with  a  series  of  painless  concussion-blows.  A 

*The  author  has  not  had  a  sufficient  number  of  cases  of  neuralgia  of  the  trigeminus 
nerve  to  test  the  value  of  freezing  and  the  slow  sinusoidal  current  (one  electrode 
to  the  back  of  the  neck  and  a  smaller  electrode  over  the  Gasserian  ganglion). 
The  suggestion  having  been  given,  however,  dentists  may  elaborate  on  the 
method  and  test  its  efficiency. 

374 


S  e  g  m    e    n    t  a   I-  -'Freezing 

strong  current  must  be  used  and  the  duration  of  the  seance 
must  not  be  less  than  five  minutes.  Small  electrodes  are 
placed  on  either  side  of  the  spinous  process  (corresponding 
to  the  segment),  or,  if  more  spinous  processes  represent  the 
segmental  area  of  pain,  the  electrodes  are  placed  along  the 
line  of  the  spine  so  as  to  cover  the  entire  segmental  area. 

SEGMENTAL  -PS  YCHROTHERAPY. 

Reference  has  already  been  made  on  page  172  to  the 
subject  of  psychrotherapy.  Freezing  acts  more  rapidly 
than  the  slow  sinusoidal  current  and  concussion  in  producing 
segmental  analgesia.  It  is  used  exclusively  by  the  author  in 
influencing  visceral  sensation.  The  effects,  however,  in 
comparison  with  the  other  methods  are  not  as  permanent, 
and  one  is  handicapped  in  its  repetition  by  the  soreness  of 
the  skin  which  it  produces.  It  may  be  repeated,  however, 
several  days  in  succession  when  ether  is  employed  for 
congelation. 

To  inhibit  peripheral  and  visceral  pain  either  the  spinous 
process  over  the  segmental  area  is  frozen  or  what  is  equally 
efficient,  freezing  is  executed  over  the  areas  of  vertebral 
tenderness  corresponding  to  the  point  of  exit  of  the  spinal 
nerves  from  a  given  segment. 

A  patient  has  a  painful  shoulder-joint  in  association 
with  a  neuritis.  Manipulation  of  the  joint  develops 
areas  of  vertebral  tenderness  (previously  absent)  at  the 
points  of  exit  of  the  2nd,  3rd  and  4th  spinal  nerves. 
These  areas  are  marked  with  a  pencil.  Pressure  over 
the  sensitive  nerve  develops  an  area  of  vertebral  tender- 
ness at  the  7th  cervical  nerve  corresponding  to  a  point 
between  the  spines  of  the  6th  and  7th  cervical  spines. 
The  latter  area  is  also  marked  with  a  pencil.  Thorough 
freezing  over  the  2nd,  3rd  and  4th  spinal  nerves  inhibits 
the  pains  in  the  shoulder-joint  and  freezing  over  the  2nd, 

375 


S   p    o     n    d    y    I    o     t    h     e    r    a    p    y 

3rd  and  4th  spinal  nerves  arrests  the  pains  of  the  neuritis. 
The  treatment  to  be  effective  must  be  repeated  daily. 
In  some  instances  it  is  advisable  to  freeze  not  only  the 
points  of  exit  of  the  spinal  nerves,  but  likewise  the  seg- 
ments corresponding  to  these  nerves.  In  intractable 
cases,  the  author  has  recourse  to  re-enforced  freezing 
(page  173)  or  he  connects  a  large  hypodermic  needle 
with  his  atomizer  by  means  of  rubber  tubing  and  freezes 
(with  ether)  the  subcutaneous  tissues  by  aid  of  the  needle. 


SEGMENTAL- AN  ALGESIA  OF  THE  VISCERA. 

The  reader  is  referred  to  page  58,  where  consideration 
was  given  to  the  dermatomes  of  Head.  It  may  be  observed 
that  the  latter  noted  that  the  distribution  of  the  lesions  in 
patients  with  herpes  zoster  corresponded  with  the  areas 
of  cutaneous  pain  and  tenderness  occurring  in  certain 
visceral  affections  and  by  comparing  the  areas  implicated 
in  cases  of  herpes  zoster  with  disturbances  of  sensation  in  a 
number  of  cases  of  nervous  diseases  (with  lesions  of  the 
spinal  cord),  he  was  able  to  map  out  the  dermatomes.  The 
latter  correspond  to  the  segments  of  the  cord  and  not  to  the 
peripheral  distribution  of  the  posterior  roots. 

In  the  following  table  the  author  has  located  the  segments 
of  the  cord  related  to  the  viscera  after  the  following  manner ; 
repeated  manipulation  of  a  sensitive  viscus  will  develop  an 
area  of  vertebral  tenderness  corresponding  to  the  roots  of 
the  spinal  nerves.  Having  located  the  sensitive  nerves,  it 
was  not  difficult  to  trace  their  relation  to  definite  spinal- 
segments. 

376 


S  e  g  m   e   n   t  a   I   -Analgesia 


SPINAL-SEGMENTS  ASSOCIATED   WITH  ViSCERAL  SENSATION.* 


ORGAN. 


SEGMENT  OF  CORD. 


RELATION  TO 
SPINOUS  PROCESS. 


Heart. 
Lungs. 


Breast. 

Esophagus. 

Stomach. 

Stomach  (Cardiac 
end). 

Stomach  (Pyloric 
end). 

Intestines. 

Appendix. 

Rectum. 

Spleen. 

Liver  and  Gall- 
bladder. 

Kidney. 

Ureter. 

Bladder. 

Prostate. 

Epididymis. 
Testicle  and  Ovary. 
Uterus  and 
appendages. 


III  C  and  I,  II,  III  D. 

IV  C  and  I,  II,  III,  IV, 
V,  VI,  VII,  VIII,  IX 
D. 

IV  and  V  D. 

V,  VI,  VIII  D. 

Ill  and  IV  C  and  VI, 

VII,  VIII,  IX  D. 
VI  and  VII  D. 

IX  D. 

IX,  X,  XI  and  XII  D. 

X  and  XI  D. 
II,  III,  IV  S. 

XI  D. 

VII,  VIII,  IX,  X  D. 

X,  XI,  XII  D. 

XII  D  and  I  L. 

XI,  XII  D,  I  L  and  I,  II, 
III  S. 

X,  XI,  XII  D,  III  L  and 

I,  II,  III  S. 

XI,  XII  D  and  I  L. 
X  D. 

X,  XI,  XII  D,  I  Land  I, 

II,  III,  V  S. 


and,  6th  and  yth  C. 
2nd,  6th,  7th  C  and  ist, 

2nd,  3rd,  4th  and  5th 

D. 

ist  and  2nd  D. 
2nd,  3rd,  4th  and  5th  D. 
ist  and  2nd  C  and  3rd, 
4th  and  5th  D. 
3rd  and  4th  D. 

5th  D. 

5th,  6th,  yth,  8th  D. 

7th  D. 

i2th  D. 

7th  D. 

4th,  5th  and  6th  D. 

6th,  7th,  8th  D. 

8th,  Qth  D. 

7th,  8th,  gth,  1 2th  D. 

6th,  7th,  8th,  loth,  i2th 

D. 

7th,  8th,  9th  D. 
6th  D. 
6th,  7th,  8th,  gth,  i2th 

D. 


SEGMENTAL- ANALGESIA  IN  DIAGNOSIS. 

"The  Paris  Neurological  Society"  concluded  that  all  the 
symptoms  legitimately  included  under  hysteria  are  imposed 
by  suggestion,  and  this  conclusion  refers  with  all  cogency 
to  the  traumatic  neuroses.  The  latter,  it  is  argued  (spinal 
commotion),  cannot  give  rise  to  symptoms  of  the  character 

*C,  cervical;  D,  dorsal;  L,  lumbar;  S,  sacral. 

377 


S    p     o    n    d    y    I    o     t    h     e     r    a   p   y 

and  duration  complained  of  by  the  victims  of  "railway 
spine."  The  foregoing  contention  cannot  be  correct  inso- 
much as  the  author  has  endeavored  to  show  that  concus- 
sion of  definite  spinal- segments  in  even  normal  subjects 
will  produce  analgesia  and  anesthesia  in  definite  regions 
of  the  body. 

Suggested,  auto-suggested  and  hysteric  pains  are  amenable 
to  diagnosis  by  segmental-analgesia. 

Let  one  assume  that  the  patient  has  a  joint-pain.  If  the 
skin  over  the  segment  corresponding  to  the  joint  in  question 
is  frozen,  or  the  spine  is  concussed,  temporary  evanescence 
of  the  pain  should  ensue.  The  foregoing  observation  is 
equally  applicable  in  the  hyperalgesia  of  neurasthenic 
patients. 

NEURALGIC  PAINS  may  be  peripheral,  i.  e.,  they  are  local- 
ized in  areas  corresponding  exactly  to  the  peripheral  dis- 
tribution of  the  nerve-trunk  or  nerve  involved  (Fig.  94). 

Here,  thorough  freezing  over  the  entire  area  of  sensitive- 
ness will  inhibit  the  pains.  The  pains  may  be  due  to  irritation 
of  the  sensory  roots.  Here,  freezing  at  the  vertebral  exit  of 
the  affected  nerves  will  assuage  the  pains. 

The  pains  may  be  intravertebral  in  origin  (spinal-tumors, 
tabes,  myelitis,  syringomyelia,  etc.)  Here,  freezing  of  the 
spinal  segments  is  alone  effective  in  inhibiting  the  pains. 

In  pains  of  visceral  origin,  the  author  employs  freezing 
to  the  exclusion  of  other  expedients  in  diagnosis. 

Let  us  assume  that  the  differential  diagnosis  rests  between 
an  appendicitis  and  a  liver  or  gall-bladder  disease.  Referring 
to  the  table  on  page  377,  it  will  be  noted  that  the  loth  and 
nth  dorsal  segments  are  related  to  the  appendix.  If  now, 
one  freezes  thoroughly  the  region  corresponding  to  this 
segment  (7th  dorsal  spine),  the  pains,  if  caused  by  appen- 
dicitis, will  be  inhibited. 

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Physiology     of    Methods 

Again,  after  such  freezing,  the  previously  sensitive 
appendix  may  be  palpated  without  pain.  . 

Thus  it  is,  one  may  exclude  definite  viscera  as  implicated 
in  disease. 

Assuming  one  has  palpated  a  sensitive  organ  supposed 
to  be  the  kidney. 

In  the  table  already  referred  to,  the  6th,  yth  and  8th 
dorsal  spines  are  related -to  the  segments  associated  with 
the  kidney.  If  the  spines  in  question  are  concussed  or 
the  skin  over  them  is  frozen,  manipulation  of  the  organ  (if 
it  is  the  kidney)  should  be  painless. 

The  dermatomes  of  Head  should  no  longer  be  in  evidence 
if  definite  spinal -segments  related  to  the  different  viscera 
are  frozen  or  concussed. 

Associated  painful  areas  related  to  visceral  disease  (Fig. 
27)  should  disappear  when  the  segments  corresponding  to 
the  viscera  are  concussed,  sinusoidalized  or  frozen. 

In  visceral  disease,  the  irritation  develops  an  area  of 
vertebral  tenderness  which  is  accentuated  by  palpation  of  a 
sensitive  organ  (page  369).  Here,  freezing  of  the  area 
of  tenderness  will  not  only  inhibit  the  pain,  but  will  permit 
of  painless  palpation  of  the  organ.  The  vertebral  tenderness 
from  cutaneous  or  visceral  irritation  is  usually  temporary 
in  duration,  and  when  the  tenderness  persists,  it  is  probably 
due  to  changes  in  the  roots  of  the  spinal  nerves  (ascending 
neuritis).  It  is  in  this  way  only  that  one  is  able  to  account 
for  the  pains  which  outlast  the  cure  of  a  visceral  disease 
(excluding,  of  course,  conditions  in  juxtaposition  to  the 
organ).  The  author  has  never  been  able  to  influence  the 
sensibility  of  the  rectum. 

PHYSIOLOGY  OF  SPONDYLOTHERAPEUTIC  METHODS. 

Physiologists  are  not  in  accord  whether  the  spinal  cord, 

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Spondyloth     e    r    a    p    y 

like  the  peripheral  nerves,  reacts  directly  to  electric  and 
mechanic  stimuli.  Those  who  oppose  the  excitability  of 
the  cord  claim  that  any  reaction  is  dependent  on  stimulation 
of  the  roots  of  the  spinal  nerves  which  give  rise  to  move- 
ments or  sensation. 

The  clinician,  however,  has  evidence  to  show  that  the 
spinal  cord  is  excitable  to  direct  stimulation. 

Experiments  show  that  most  motor  nerve-cells  discharge 
their  motor  impulses  at  a  rate  of  about  ten  per  second,  and 
if  these  cells  are  stimulated  artificially,  the  motor  discharge 
is  about  the  same  rate  as  the  normal. 

This  reaction  of  the  nerve-cells  of  the  cerebrum  and  cord 
is  endowed  with  a  definite  rhythm  which  has  been  com- 
pared with  the  rhythmical  beat  of  the  heart. 

After  the  discharge  of  an  impulse  the  cells  fall  into  a 
refractory  phase  for  a  period  of  time  lasting  about  o.i 
second.  When  a  nerve-cell  has  discharged  a  strong  impulse 
as  a  consequence  of  summation  of  its  stimuli,  it  is  exhausted, 
and  requires  a  certain  time  to  be  recharged. 

CONCUSSION  is  a  mechanic  stimulus  and  is  equivalent  to 
a  blow,  pressure,  pinching  or  section.  Mechanic  stimuli  are 
only  effective  when  they  are  applied  with  sufficient  rapidity 
to  produce  a  change  in  the  form  of  the  nerve-particles. 
When  a  motor  nerve  is  stimulated,  the  resultant  is  motion 
and  pain  if  a  sensory  nerve  is  stimulated. 

If  the  continuity  of  the  nerve  is  interrupted  or  the  molec- 
ular arrangement  is  disturbed  by  a  mechanic  stimulus, 
conduction  of  an  impulse  is  interrupted  and  the  excitability 
of  a  nerve  is  either  diminished  or  extinguished.  In  con- 
clusion one  may  say  that  concussion  of  short  duration 
augments  the  excitability  of  the  nerves,  but  when  prolonged, 
the  excitability  is  diminished  or  abolished. 

PRESSURE   if  continued  upon  a  mixed  nerve,  paralyzes 

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Physiology     of    Methods 

the  motor  earlier  than  the  sensory  fibers.  If  the  pressure 
is  applied  gradually,  the  nerve  may  be  rendered  inexcitable 
without  demonstrating  any  evidence  of  its  being  stimulated. 
Pressure  on  a  mixed  nerve  extinguishes  reflex  conduction 
sooner  than  motor  conduction. 

SINUSOIDALIZATION  is  the  equivalent  of  an  electric 
stimulus.  An  electric  current  shows  its  most  powerful 
action  upon  the  nerves  at  the  moment  it  is  applied,  and  at 
the  moment  when  it  ceases,  and  any  increase  or  decrease 
in  the  strength  of  a  current  acts  as  a  stimulus.  When  the 
current  is  flowing  through  a  nervous  structure,  a  condition 
known  as  electrotonus  occurs,  whereby  the  physiologic 
properties  of  the  structure  are  greatly  modified. 

The  rapid  sinusoidal  current  is  stimulating,  whereas  the 
slow  sinusoidal  current  yields  a  series  of  electric  shocks. 
In  the  application  of  the  latter  current  to  the  spine  no  motor 
effects  are  observed,  the  action  being  limited  to  subduing 
the  sensory  component  of  a  spinal-segment. 

FREEZING. — The  author  has  endeavored,  by  a  series  of 
histologic  examinations,  to  explain  the  rationale  of  freezing 
as  a  remedial  agent,  but  the  microscope  affords  no  clue. 
It  certainly  does  not  act  by  counterirritation,  insomuch  as 
the  latter  shows  none  of  the  immediate  analgesic  effects  of 
congelation.  The  local  application  of  cold  probably  acts 
as  a  shock,  thereby  diminishing  the  conductivity  of  the 
nerves  and  annulling  the  functions  of  the  centers  in  the 
cord.  The  initial  contraction  of  the  vessels  and  tissues  is 
followed  by  a  greater  dilatation  andturgescence.  The  sensory 
nerves  are  paralyzed  with  loss  of  sensibility.  In  fact,  when 
the  temperature  is  sufficiently  low,  the  excitability  of  all 
the  nerves  is  diminished. 


381 


S   p     o    n     d    y    I    o     t    h     e     r    a   p    y 

SPINAL   NERVE -TRUNK   ANALGESIA. 

It  is  known  that  if  cocain  is  injected  into  the  tissues  about 
a  nerve- trunk,  anesthesia  follows  in  the  area  supplied  by  the 
nerve.  Anesthesia  ensues  in  about  five  minutes  and  lasts  about 
fifteen  minutes.  It  is  evident  that  if  the  injection  is  effective, 
there  is  an  absolute  block  to  the  transmission  of  afferent  and 
efferent  impulses.  The  foregoing  fact  is  of  great  importance 
in  spondylodiagnosis  and  spondylotherapy. 

For  local  anesthesia,  cocain  is  usually  employed,  but 
owing  to  the  occasional  toxic  symptoms  arising  from  its 
use,  it  has  been  substituted  by  eucain  hydrochlorate,  stovain 
and  other  local  anesthetics. 

The  danger  from  cocain  is  minimized  if  the  following 
precautions  are  taken:  i,  Never  inject  more  than  one- third 
of  a  grain  hypodermatically;  2,  Never  inject  the  drug  into  a 
vein;  3,  Never  use  it  if  the  kidneys  are  inefficient;  4,  The 
patient  should  be  in  the  recumbent  posture;  5.  Use  the  infil- 
tration-anesthesia of  Schleich.  Schleich's  formula  may  now 
be  obtained  in  tablets  and  one  tablet  is  dissolved  in  100 
minims  of  sterilized  water.  This  formula  is  absolutely 
innocuous:  the  formula  No.  3  containing  only  i-ioo  grain 
of  cocain. 

The  infiltration  can  be  made  painless  by  touching  the 
point  where  the  needle  is  inserted  with  pure  carbolic  acid 
or  by  freezing  the  spot.  It  is  well  to  remember  that  if  one- 
quarter  of  a  pound  of  ice  (broken  into  fine  bits)  is  mixed 
with  one-eighth  of  a  pound  of  salt  and  placed  in  a  gauze- 
bag,  the  application  of  the  latter  to  a  part  causes  analgesia 
in  about  fifteen  minutes. 

A  hot  solution  of  the  Schleich  formula  is  more  efficient 
than  a  cold  solution. 

A  moderately  long  needle  attached  to  the  barrel  of  the 

382 


Cortical       Sinusoidalixation 

syringe  is  used  and  made  to  penetrate  the  tissues  of  the  back 
approximating  the  exit  of  the  spinal  nerves  as  shown  in 
Fig.  10.  Assuming  that  one  wishes  to  make  the  ulnar  nerve 
analgesic.  Reference  to  Fig.  10  shows  that  the  nerve  from 
which  it  arises  makes  its  exit  between  the  yth  and  ist  dorsal 
vertebrae  and  between  the  ist  and  2nd  dorsal  vertebrae, 
hence  the  infiltration-anesthesia  must  include  the  para- 
vertebral  area  in  question. 

One  may  also  recall  the  fact,  if  cocain,  or  its  substitutes, 
are  interdicted,  that  infiltration  of  the  tissues  with  warm  or 
cold  sterile  water  is  often  very  efficient  in  causing  anesthesia. 

CORTICAL  SINUSOID ALIZATION.* 

In  1870,  Herbert  Spencer  declared  that  different  parts 
of  the  cerebrum  must  subserve  different  kinds  of  mental 
action. 

Hughlings  Jackson  affirmed  that  the  gray  matter  of  the 
convolutions  was  really  excitable,  but  physiologists  regarded 
his  observations  as  ingenious  speculations  insomuch  as  there 
was  no  evidence  that  the  cerebral  cortex  responded  to  any 
of  the  ordinary  stimuli  of  nerves. 

In  1870,  Fritsch  and  Hitzig,  established  a  new  era  in 
cerebral  physiology,  viz.,  that  the  application  of  the  galvanic 
current  to  the  surface  of  ike  cerebral  hemisphere  in  dogs, 
gave  rise  to  movements  on  the  opposite  side  of  the  body. 
The  latter  are  movement  complexes  bringing  into  play 
several  muscles  concerned  in  various  movements  or  acts 
and  not  individual  muscles.  Thus,  the  effect  of  injury  to 
a  definite  area  of  the  cerebral  cortex  is  the  inability  to 
execute  particular  movements  or  acts. 

*The  author's  reference  to  this  subject  is  in  the  nature  of  a  preliminary  report. 
Its  intimate  relation  to  the  vertebral  reflexes  (page  7)  justifies  its  consideration. 
It  has  only  been  investigated  physiologically,  but  its  possibilities  in  clinical 
pathology  are  far-reaching. 

383 


S  p     o     n    d    y    I    o    the    r    a    p    y 

Our  knowledge  concerning  the  psychomotor  area  in  the 
cerebral  cortex  emanates  from  the  following  sources:  i, 
Experiments  upon  the  cerebral  cortex  of  monkeys;  2,  Electric 
stimulation  of  the  cortex  in  human  subjects  during  the 
progress  of  a  cerebral  operation  for  the  object  of  localizing 
a  diseased  area;  3,  Clinical  observations  confirmed  by 
autopsy  in  cases  of  cerebral  tumors  and  Jacksonian  epilepsy. 


FIG.  97. — Localization  of  the  motor  area.  This  may  be  determined  approxi- 
mately by  drawing  two  perpendicular  lines,  one  from  the  depression  in  front  of 
the  external  meatus,  and  the  other  from  the  posterior  border  of  the  mastoid  process 
at  its  root;  f,  most  prominent  part  of  parietal  eminence. 

It  has  already  been  shown  that  spinal  muscular  reflexes 
could  be  elicited  by  sinusoidalization  of  definite  spinal 
segments  (page  n),  and  it  occurred  to  the  author  that  the 
motor  area  of  the  cerebral  cortex  could  be  similarly  in- 
fluenced. That  this  is  true  is  evidenced  by  execution  of 
the  following  method:  Having  cocainized  the  skin  of  a 
bald-headed  individual,  corresponding  to  the  motor  area 

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Cortical       Sinusoidalixation 

(Fig.  97),  a  powerful  sinusoidal  current  (rapid  sinusoidal 
from  the  Victor  or  the  Kellogg  apparatus)  was  conveyed 
to  the  motor  area  either  by  an  interrupting  bipolar  electrode 
or  with  one  interrupting  electrode  over  the  motor  area  and 
the  other  over  the  sternum.  By  opening  and  suddenly 
closing  the  circuit,  muscular  contractions  were  observed  in 
the  muscles  of  the  face,  arm  and  leg  on  both  sides  of  the 
body.  Later,  it  was  found  that  local  anesthesia  was  un- 
necessary to  obtain  contractions  of  the  muscles  of  the  face 
and  arm.  It  is  better  to  employ  a  bipolar  interrupting 
electrode  over  the  motor  area  to  exclude  from  participation 
in  the  muscular  contractions  the  motor  areas  of  the  cord. 

One  must  not  conclude  that  because  the  co-ordinated 
movements  do  not  occur  exclusively  on  the  opposite  side 
of  the  body,  the  clinical  observations  of  the  author  do  not 
correspond  with  the  physiologic  evidence. 

On  the  contrary,  stimulation  of  an  area  on  one  side  in 
animal  experimentation  results  in  bilateral  movements  in 
the  case  of  corresponding  muscles  on  opposite  sides  of  the 
body  that  usually  act  together.  Thus,  Exner  contends  that 
such  muscles  appear  to  have  a  center  not  only  in  the  opposite 
but  also  in  the  hemisphere  of  the  same  side.  All  observers 
have  noted  that  stimulation  of  the  facial  center  results  in 
identical  movements  on  both  sides  of  the  face. 

It  has  always  been  a  question  with  physiologists  whether 
similar  areas  exist  in  man.  If  the  evidence  adduced  by  the 
author  is  sufficient,  the  question  may  be  answered  in  the 
affirmative. 

By  placing  one  electrode  of  a  slow  sinusoidal  current 
(Victor  apparatus)  over  the  sensory  area  (Fig.  97)  and  the 
other  at  an  indifferent  point  and  using  a  strong  current  for 
about  ten  minutes,  a  moderate  grade  of  hemianesthesia 
may  be  produced  on  the  opposite  side  of  the  body.  Both 

385 


S    p     ondylotherapy 

sides  of  the  body  may  be  similarly  anesthetized  by  fixing 
the  electrodes  on  either  side  of  the  cranium  corresponding 
to  the  psychosensory  centers  of  the  cortex. 


386 


R      e      f     I      e      x 


CHAPTER  XII. 

THE    REFLEXES*    AND    THE   PERIPHERAL    SYMPTOMATOLOGY 
OF  VISCERAL  DISEASE. 

PURPORT  or  SPONDYLOTHERAPY — GENERAL  FEATURES  OF  REFLEXES 

— THERAPEUTICS  OF  REFLEXES — THERAPEUTICS  OF  CONCUSSION 
— COMPARISON  OF  METHODS — TROPHIC  FUNCTIONS  OF  CORD — 
TROPHIC  DISEASES — PERIPHERAL  REFLEX  PHENOMENA — INSUF- 
FICIENCY OF  THE  FOOT — TEST  FOR  THE  SPLANCHNIC  CIRCULATION 
— REFLEXES  OF  THE  CRANIAL  NERVES. 

THE  PURPORT  OF    SPONDYLOTHERAPY. 

TT  7"HEN  the  author  first  suggested  the  neologism,  SPON- 
DYLOTHERAPY, he  anticipated  no  misconception  con- 
cerning its  object,  yet  "THE  JOURNAL  OF  THE  AMERICAN 
MEDICAL  ASSOCIATION"  conceived  the  following  analysis  of 
the  work  in  question : 

" One  wonders  whether  this  is  an  attempt  to  explain 
osteopathy  and  chiropractic  to  the  understanding  of  the  regular 
practioner,  or  to  exploit  the  very  ingenious  percussion  devices 
of  the  author,  or  whether  it  is  really  true  that  medical  men 
really  know  practically  nothing  about  the  cure  of  disease 
through  treatment  of  the  spine.  Let  us  hope  that  it  is  the  latter, 
and  that  a  careful  study  of  this  unique  volume  may  open  new 
avenues  of  therapy  heretofore  undreamed  of." 

Now,  osteopathy  is  a  system  which  concerns  itself  with 
anatomic  abnormalities  and  their  correction.  "Its  nosology 
is  a  lesion,  its  symptomatology  a  subluxation." 

*The  reader  should  consult  the  index  to  find  the  fundamental  facts  concerning 
the  visceral  reflexes. 

387 


S  p    o     n     d    y    I    o     t    h     e    r    a    p    y 

Chiropractic  presumes  disease  to  .emanate  from  displaced 
vertebrae. 

The  Spinal  centers  are  referred  to  in  osteopathic  and 
chiropractic  textbooks,  "with  a  dogmatism  and  certainty 
begotten  of  beneficial  results." 

SPONDYLOTHERAPY  concerns  itself  only  with  the  excita- 
tion of  the  functional  centers  of  the  spinal  cord  by  different 
methods  which  may  be  executed  and  demonstrated  with  the 
same  certainty  in  the  living  human  subject  as  is  done  by  the 
vivisectional  experimentalist.  (This  phase  of  medicine  is 
referred  to  by  the  author  as  "Clinical  Physiology"}  In 
brief,  Spondylotherapy  is  based  on  the  clinical  physiology  of 
the  human,  in  contradistinction  to  the  study  of  physiology 
by  the  laboratory  vivisectionist.  Thus  human,  and  not 
animal  physiology,  is  made  the  basis  of  clinical  pathology. 
In  this  way  one  has  disproved  by  clinical  observation  many 
apodictic  data  created  in  the  laboratory. 

Whereas  spondylophysiology  concerns  itself  with  a  study 
of  the  spinal  reflexes,  the  therapeutics  of  the  latter  is  embraced 
by  the  designation,  spondylotherapy. 

SPONDYLOPATHOLOGY. — Life  is  expressed  by  a  rhythmic 
flow  of  automatic  functions  known  as  reflexes.  Each  reflex 
has  its  antagonistic  reflex  and,  when  both  are  co-ordinated, 
the  result  is  a  physiologic  condition. 

When  they  are  in  a  state  of  inco-ordination,  the  result  is 
a  pathologic-physiologic  condition.  According  to  this  con- 
ception of  spondylology,  pathology  is  founded  on  physiology, 
and  pathology  is  nought  else  but  the  physiology  of  the  sick. 
Thus,  a  pathologic-physiologic  condition  creates  its  own  patho- 
logic anatomy.  That  is,  instead  of  regarding  the  morbid 
tissue-change  as  a  primary  requisite  of  disease,  it  is  in  reality 
secondary  to  physiology  in  a  state  of  disequilibration.  The 
real  object  of  the  practice  of  medicine  is  to  cure  disease  and 

388 


The        R      e     f     I      e      x      e        s 

it  is  only  the  doctrinaire  whose  fealty  invokes  the  Skodaic 
pessimism:  "We  can  diagnose  disease,  describe  it,  and  get  a 
grasp  of  it,  but  we  dare  not  by  any  means  expect  to  cure  it." 
Thus  the  soulless  philosophy  which  is  too  generally  accepted 
as  scientific  medicine  permits  the  scientist  to  diagnose 
diseases  while  the  charlatan  cures  them." 

Conservative  medicine  is  too  often  a  practice  of  trusting 
to  nature  and  confirming  the  diagnosis  at  the  autopsy. 

We  are  inclined  to  forget  the  Hippocratic  allusion  to 
medical  art;  that  it  consists  of  three  things — the  patient,  his 
malady  and  the  physician. 

This  is  the  era  of  therapeutic  medicine,  and  he  who  prates 
about  the  bankruptcy  of  therapeutics,  substitutes  the  guinea- 
pig  for  a  human  and  the  laboratory  for  the  bedside. 

Therapeutic  nihilism  owed  its  conception  to  the  path- 
ologist, who  sought  to  identify  every  disease  with  definite 
anatomic  changes,  and  his  coadjutor,  the  clinician,  studied 
disease  only  in  relation  to  these  anatomic  conditions.  Thus, 
the  clinician  perpetrated  the  egregious  mistake  of  associating 
the  autopsic  findings  with  the  previous  disease,  whereas,  as 
a  matter  of  fact,  the  anatomic  changes  were  sequential 
to  the  disease  and  not  the  disease  itself.  In  other 
words,  a  perturbed  physiology  created  its  own  pathologic 
anatomy. 

One  of  the  most  epoch-making  developments  of  modern 
medicine  is  "Physiologic  Therapeutics,"  which  regards 
disease  as  an  expression  of  morbid  physiology  and  all  that 
affects  health,  affects  disease  and  that,  to  promote  recovery, 
one  must  influence  the  general  health. 

That  disease  is  nought  else  but  physiology  gone  mad  is 
illustrated  in  bacteriotherapy  and  in  our  modern  conception 
of  semeiology.  Thus,  the  inutility  of  bactericides  in  the 
treatment  of  infectious  diseases  led  to  an  investigation  of  the 

389 


Spondyloth     e    r    a    p    y 

latter  from  a  new  view-point,  viz. :  How  does  the  organism 
deal  with  infections? 

It  was  soon  demonstrated  that  the  organism  possessed 
chemical  defenses  and,  as  a  consequence,  modern  bacter- 
iotherapy  developed  the  therapeutics  of  immunity  by  utilizing 
as  antitoxins  the  same  products  which  the  animal  organism 
developed  to  combat  infection  or,  by  attempting  to  stimulate 
the  organism  to  an  augmented  production  of  such  defensive 
agents. 

Again,  we  have  misinterpreted  defensive  reflex  phenomena 
as  symptoms  of  disease.  Thus,  hyperemia,  long  regarded  as 
a  symptom,  is  now  utilized  as  a  valuable  physio-therapeutic 
method. 

Muscular  spasm,  by  immobilizing  a  diseased  joint  or 
spine,  or  by  protecting  a  sensitive  viscus,  is  an  expression  of 
defense. 

Fever  is  probably  a  salutary  process,  for  by  this  means 
the  infected  body  is  "cleansed  by  fire."  Pathogenic  bacteria 
thrive  best  at  the  normal  temperature  of  the  body  and  they 
either  die  or  lose  their  toxic  properties  with  the  commence- 
ment of  fever.  The  micro-organisms  of  malignant  pustule 
cannot  survive  a  temperature  above  104°  F.,  and  thus  can- 
not infect  birds,  whose  normal  temperature  exceeds  this  limit. 
This  immunity  however,  is  destroyed  if  the  temperature  of  the 
bird  is  reduced  artificially.  Our  present  conception  of  fever 
is  in  accord  with  the  teaching  of  Hippocrates,  that  fever  is  a 
remedy.  That  it  is  "a  reaction  of  the  organism  striving  for 
a  useful  end,  but  that  this  end  may  not  be  reached  or  that 
it  may  be  overstepped." 

GENERAL  FEATURES  OF  REFLEXES. — Reflexes  function- 
ate with  machine-like  regulation  (regulative  reflexes},  and  are 
usually  automatic,  i.  e.,  independent  of  our  own  wills.  If 
one  stimulates  the  nerve  of  taste,  there  is  a  reflex  secretion 

390 


The        Reflexes 

of  saliva  and  gastric  juice.  However,  one  dare  not  exclude 
a  psychic  factor  in  the  mechanism  of  reflexes.  Thus,  the 
mere  sight  of  food  causes  a  secretion  of  gastric  juice;  the 
heart  is  influenced  by  emotions,  and  definite  psychic  condi- 
tions influence  the  flow  of  urine.  One  of  the  most  important 
objects  of  the  reflexes  is  to  protect  the  body  from  external 
injuries.  The  protective  movements  of  pithed  or  decapitated 
frogs  are  so  purposive  in  character  and  so  co-ordinated  that 
Pflliger  regarded  them  as  directed  by  and  due  to  "conscious- 
ness of  the  spinal  cord." 

Just  as  will  may  excite  a  reflex,  it  may  also  prevent  it 
(inhibition  of  reflexes).  Thus,  at  well-regulated  sanatoria 
for  consumptives,  one  rarely  hears  a  cough.  There  patients 
are  disciplined  to  inhibit  a  cough  and  are  informed  that  to 
cough  in  public  is  as  much  a  breach  of  etiquette  as  to  scratch 
one's  head  when  it  itches.  It  is  still  dubitable  whether  there 
are  definite  inhibitory  centers  or  whether  there  are  special 
afferent  inhibitory  nerves. 

As  a  rule,  a  reflex  is  more  easily  discharged  by  stimulation 
of  the  peripheral  end-organ  than  by  stimulation  of  the  cor- 
responding afferent  nerve-trunk.  Even  though  recent  phy- 
siologic investigations  show  that  some  of  the  secretions 
are  not  reflexes  in  the  sense  that  they  are  mediated  by  the 
afferent  nerves,  yet  in  a  general  way  they  are  still  reflexes. 
It  has  been  shown  that  the  ductless  glands  elaborate  specific 
chemical  products  known  as  hormones,  which  are  manufac- 
tured in  one  organ  of  the  body  and  are  conveyed  by  the  blood 
to  another  organ  or  organs  where  they  stimulate  physiologic 
activity  by  their  presence. 

Generally  the  reflexes  are  local,  i.  e.,  they  are  discharged  in 
the  region  of  the  body  irritated.  If  the  reflex  irritability  is  in- 
creased or  if  the  stimulation  is  severe,  the  reflexes  may  be  diff- 
used to  regions  remote  from  the  area  irritated  (reflex  dispersion). 

391 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

ORIGIN  OF  THE  REFLEXES. — The  former  view  that  the 
spinal  cord  was  the  center  of  all  reflexes  is  doubtful  and  the 
following  classification  of  reflexes  by  Jendrassik  is  worthy  of 
consideration : 

1.  Spinal  Reflexes,  include  tendon,  periosteal  and  joint- 
reflexes.     They   are   usually  discharged   from   areas   with 
diminished  sensation;  are  dissociated  with  any  special  feeling; 
mechanic  irritation  (like  a  blow)  suffices  for  their  discharge ; 
the  intensity  of  the  reflex  is  based  on  the  degree  of  irritation 
and  not  upon  its  duration;  making  other  muscles  tense 
augments  the  reflex  (Jendrassik's  method  of  reinforcement); 
the  reflexes  are  augmented  when  attention  is  distracted. 

2.  Cerebral  Reflexes  include  the  cutaneous  reflexes,  and 
they  are  discharged  from  sensitive  areas.    Unlike  the  spinal 
reflexes,  they  are  increased  or  diminished  by  psychic   in- 
fluences and  distraction  of  the  attention  impairs  them. 

3.  Complex  Reflexes  include  such  which  are  made  up  of 
a  series  of  movements  like  coughing,  sneezing,  vomiting, 
defecating,  etc.    They  are  discharged  by  protracted  stimu- 
lation (summation  of  stimuli);  the  reflex  involves  different 
groups  of  muscles  and  even  antagonistic  reflexes  and  psychic 
influences  are  of  greater  moment  than  with  the  cerebral 
reflexes. 

THERAPEUTICS  OF  THE  REFLEXES.* — When  the  oculist 
contracts  or  dilates  the  pupil,  he  employs  reflexes  in  treat- 
ment. Contraction  of  the  pupil  is  controlled  by  the  oculo- 
motor nerve,  which  supplies  the  sphincter  pupillae  (and 
ciliary  muscle),  and  dilatation  of  the  pupil  is  governed  by  the 
sympathetic.  Thus  eserin,  which  stimulates  the  oculo-motor 
nerve  contracts  the  pupil,  whereas  atropin,  which  paralyzes 
the  same  fibres,  dilates  the  pupil.  Thus,  in  iritis  the  most 

*The  pharmacology  of  the  reflexes  is  discussed  in  Chapter  XIII. 

392 


The        Reflexes 

important  remedy  is  atropin,  because  among  other  effects, 
the  eye  is  put  at  rest,  owing  to  paralysis  of  the  sphincter. 

The  day  is  fast  approaching  when  improved  methods  of 
spinal  nerve-trunk  analgesia  (page  382)  will  enable  us  to 
inhibit  or  excite  reflexes  to  cure  disease.  Surgery  has  already 
invaded  this  field  in  the  treatment  of  spasticity,  by  resection 
of  the  posterior  spinal-roots  (rhizotomy).  Here,  the  object 
is  to  inhibit  afferent  impulses  from  the  muscles  which  excite 
the  cells  of  the  anterior  horns  of  the  cord  to  send  out  excessive 
motor  reflexes  to  the  muscles. 

In  the  therapeutic  elicitation  of  the  spinal  reflexes  one 
must  take  cognizance  of  the  physiologic  data  which  are 
applicable  clinically: 

1.  A  stronger  stimulus  is  necessary  to  excite  a  reflex 
movement  than  for  the  direct  stimulation  of  motor  nerves. 

2.  A  reflex  movement  is  of  shorter  duration  than  the 
same  movement  executed  voluntarily  and  there  is  a  decided 
delay  after  the  moment  of  stimulation.     The  reflex  time 
diminishes  as  the  strength  of  the  stimulus  increases. 

3.  Stimuli  must  be  regarded  as  various  forms  of  energy 
and  over  stimulation  conduces  to  exhaustion,  when  even  a 
powerful  stimulus  fails  to  elicit  a  response. 

In  other  words,  weak  irritation  augments  the  irritability 
of  the  spinal  centers;  medium  irritation  benefits  them; 
strong  decreases;  and  very  strong  abolishes  the  irritability. 

Some  of  the  failures  in  my  early  practice  in  the  appli- 
cation of  spondylotherapy  were  due  to  overstimulation  of 
the  spinal-centers.  Now,  I  make  short  and  interrupted 
seances,  a  fundamental  principle  in  treatment.  Several 
treatments  may  be  given  daily  but  they  must  be  of  short 
duration.  The  physiologist  employs  electric  in  preference 
to  mechanic  stimuli  for  the  reason  that  they  are  easily  applied 
and  their  intensity  controlled.  He  has  committed  himself  to 

393 


S  p    o     n     d    y    I    o     t    h     e    r    a    p    y 

the  Galvanic  or  Faradic  current  for  electric  stimulation  and 
the  sinusoidal  current  receives  no  consideration  in  the  text- 
books on  physiology. 

In  my  animal  experiments  I  found  the  sinusoidal  current 
used  percutaneously,  the  only  effective  one  for  elicitation  of 
the  visceral  reflexes.  With  the  use  of  strong  currents  over 
definite  vertebral  regions,  practically  every  viscus  could  be 
made  to  contract  or  dilate  at  will. 

In  association  with  contraction,  the  organ  became  anemic 
and  conversely,  hyperemic  when  the  organ  was  dilated. 
These  circulatory  modifications  were  due  no  doubt  to  the 
visceral  musculature  and  were  quite  independent  of  any 
action  on  vasomotor  centers. 

With  repetition  of  sinusoidalization,  however,  the  visceral 
reflexes  became  exhausted  and  even  the  strongest  stimulation 
was  without  effect.  After  a  period  of  rest  one  could  again 
elicit  the  reflexes  in  question. 

THERAPEUTICS  OF  CONCUSSION. — My  observations  on 
concussion,  as  presented  on  pages  175  and  380,  have  been 
further  exploited.  No  reliance  can  be  placed  on  the  average 
concussion  apparatus;  it  is  what  it  is  intended  to  be,  a  mere 
vibrator.  The  apparatus  which  the  author  employs  (Fig.  50), 
operates  with  an  average  pressure  of  40  pounds  and  yields 
a  blow  equivalent  to  12  pounds.  Unfortunately,  this  appar- 
atus is  noisy  and  compressed  air  is  not  always  obtainable. 
To  obviate  these  difficulties  the  author  has  devised  an  effi- 
cient electro-concussor. 

Methods  are  frequently  discredited  for  the  reason  that 
they  are  faultily  executed. 

A  physician  employed  the  author's  method  for  several 
months  in  a  case  of  aneurysm  of  the  thoracic  aorta  without 
results.  The  patient  got  progressively  worse  and  the  con- 
dition was  apparently  hopeless.  My  colleague  had  employed 

394 


The        Reflexes 

a  mere  vibratory  toy  for  treatment.  Within  a  few  seances, 
after  vigorous  concussion  of  the  seventh  cervical  spine,  the 
patient  began  to  progress  rapidly  toward  recovery.  The 
author  has  repeatedly  demonstrated  that  vibration  will  not 
elicit  a  visceral  reflex,  hence  it  is  of  no  avail  in  treatment. 
In  the  absence  of  a  trustworthy  apparatus,  the  method 
shown  in  Fig.  2  should  be  used.  Several  physicians  have 
successfully  employed  the  latter  method  exclusively  in  the 
treatment  of  aneurysms. 

Some  physiologists  deny  the  excitability  of  the  spinal 
cord  and  attribute  any  reaction  to  stimulation  of  the  roots 
of  the  spinal  nerves.  On  page  170  (Fig.  48),  reference  is 
made  to  the  elicitation  of  visceral  reflexes  by  paravertebral 
pressure*  Now,  if  one  compares  the  results  of  pressure 
with  a  special  instrument  (Fig.  112),  at  definite  paravertebral 
areas,  with  concussion  executed  in  the  usual  way  (concussors 
applied  directly  to  the  spinous  processes),  the  following 
results  were  obtained  in  the  same  subject,  with  the  stomach 
reflex  of  contraction : 

After  five  minutes  concussion  of  the  first  lumbar 
spine  the  amplitude  of  the  reflex  was  2  cm.,  and  its  dur- 
ation, one-half  minute.  After  pressure  on  both  sides  of 
the  first  lumbar  spine  for  one-half  minute,  the  amplitude 
of  the  reflex  was  3  cm.,  and  its  duration,  15  minutes. 
Here,  the  results  were  clearly  shown  to  be  due  to  nerve- 
trunk  stimulation  and  not  to  segmental  excitation. 

Later,  the  author  evolved  a  special  kind  of  metallic 
concussor,  as  shown  in  Fig.  98,  which  concusses  both 
sides  of  the  spinous  process,  instead  of  direct  concussion 
of  the  latter. 

This  concussor  fitted  into  the  pneumatic  hammer,  or  the 
apparatus  of  the  author,  elicits  visceral  reflexes  of  greater 

*Vide  Chapter  XIII  for  a  more  extended  discussion  of  this  subject. 

39* 


S  p    o    n    d    y    I    o     t    h     e     r    a    p    y 

amplitude  and  of  longer  duration  than  when  the  spines  are 
directly  concussed. 

SLOW  AND  RAPID  CONCUSSION. — The  physiologist  attains 
different  results  from  stimulation  according  to  whether  the 
stimulus  is  applied  rhythmically  at  a  slow  or  rapid  rate. 


Fig.  98. — Concussor  which  delivers  blows  to  both  sides  of  a  spinous  process. 
It  is  of  metal  and  covered  with  layers  of  felt  and  rubber  to  eliminate  any  possible 
traumatism  resulting  from  concussion. 

My  clinical  results  are  in  accord  with  the  foregoing  obser- 
vation. 

Thus,  a  liver  by  percussion  measures  12  cm.;  after 
rapid  and  continuous  concussion,  it  measures  8  cm.,  and 
after  slow  and  interrupted  concussion-blows,  it  is  still 
further  reduced  to  6  cm.  After  concussion  of  the  first 
three  lumbar  spines  to  elicit  the  stomach  reflex  of  con- 
traction, rapid  blows  caused  a  recession  of  1.7  cm.  of  the 
lower  border  of  the  stomach,  whereas  slow  and  inter- 
rupted blows  resulted  in  a  recession  measuring  3.5  cm. 

In  this,  as  in  all  other  recorded  observations,  the 
same  blow  and  pressure  were  used  and  the  duration  of 
treatment  was  the  same.  For  the  purpose  of  contracting 
the  viscera,  slow  and  interrupted  concussion-blows  are 
more  efficient  than  rapid  and  continuous  blows. 

396 


The        Reflexes 

To  secure  dilatation  of  blood-vessels,'  the  slow  and 
interrupted  concussion-blows  are  equally  more  efficient. 
Thus,  in  an  aneurysm  which  has  a  transverse  diameter 
of  6  cm.,  rapid  and  continuous  blows  to  elicit  the  aortic 
reflex  of  dilatation  increase  the  diameter  to  8.3  cm.,  where- 
as slow  and  interrupted  blows  increase  the  diameter  to 
9.5  cm. 

To  contract  blood-vessels  (and  aneurysms),  rapid 
and  continuous  blows  are  more  efficient. 

Thus,  an  aneurysm  with  a  diameter  of  7  cm.,  is,  after 
slow  and  interrupted  blows  to  elicit  the  aortic  reflex  of 
contraction,  reduced  to  a  transverse  measurement  of 
5.8  cm.,  whereas,  after  rapid  and  continuous  blows, 
the  transverse  diameter  is  reduced  to  i  cm. 

COMPARISON  or  METHODS. — It  is  only  possible  in  a 
general  way  to  say  what  is  the  most  efficient  method  for  elicit- 
ing the  visceral  reflexes. 

Like  all  cells,  the  neurones  do  not  react  to  the  same 
stimulus.  Electricity  with  weak  currents  increases,  and 
strong  currents  decrease  the  activity  of  the  cells. 

Unfortunately  few  physicians  are  sufficiently  skilled  in 
percussion  to  determine  for  themselves  the  best  method  to 
employ.  Very  often  the  rapid  sinusoidal  current  is  more 
efficient  than  concussion.  Thus,  in  a  patient  with  an  aortic 
aneurysm,  the  following  comparative  results  were  obtained 
in  eliciting  the  aortic  reflex  of  contraction: 

METHOD.  DURATION  OF  TREATMENT.     DURATION  OF  REFLEX. 

Concussion.  i  min.  to  yth  cervical  12  minutes. 

spine. 
Rapid  sinusoidal  current.       i  min.  to  both  sides  of      36  minutes. 

same  spine. 

STOMACH  REFLEX  OF  CONTRACTION. 

METHOD.  DURATION  OF  TREATMENT.  DURATION  OF  REFLEX. 

Slow    blows    directly    to       One-half  minute.  3  minutes  and  3 5  seconds. 

spinous  process. 
Slow  blows  to  both  sides       One-half  minute.  16  minutes. 

of  spinous  process. 
Slow  sinusoidal  current  to       One-half  minute.  8  minutes. 

to  both  sides  of  spine. 

397 


Spondyloth     e     r    a    p    y 


VASODILATOR  LUNG  REFLEX.* 


(Application  to  the  loth  dorsal  spine.) 


METHOD. 

Concussion. 

Rapid  sinusoidal  current. 
Slow  sinusoidal  current. 
High-frequency  current. 
Paravertebral  pressure. 


DURATION  OF  TREATMENT. 

i  minute, 
i  minute, 
i  minute, 
i  minute, 
i  minute. 


DURATION  OF  REFLEX. 

45  seconds. 
6  minutes. 
No  result. 
4  min.,  10  sec. 
10  minutes. 


VVhen  pressure  exceeded  one  minute,  the  dullness  was  of  short  duration. 

The  reflexes  are  more  easily  exhausted  by  pressure  than  by  any  other  method. 

For  discharging  visceral  reflexes,  the  rapid  sinusoidal  current  is  always  more 
efficient  than  the  slow  current.  With  different  sinusoidal  machines  one  secures 
discordant  results. 


Fig.  99. — The  Mclntosh  polysine  generator. 


*This  reflex  is  fully  discussed  in  Chapter  XVI,  page  606,  and  is  associated  with 
dullne?*  of  the  lung.    Here,  duration  of  reflex  refers  to  the  duration  of  dullness. 

398 


The        Reflexes 

In  my  investigations,  the  Polysine  Generator  (Fig.  99), 
made  by  the  Mclntosh  Battery  and  Optical  Co.,  of  Chicago, 
was  employed.  The  dial  selector  attached  to  this  apparatus 
obviates  the  necessity  of  learning  by  rote  the  operation  of 
the  many  switches  in  order  to  obtain  the  required  combi- 
nations. 

The  high-frequency  current,  applied  by  means  of  a  double 
vacuum  electrode  (Fig.  100),  to  either  side  of  definite  spines, 


Fig.  100. — Double  Vacuum  Electrode. 

will  elicit  visceral  reflexes  of  great  amplitude  and  long  dur- 
ation. For  this  purpose,  in  some  instances  it  is  more  effective 
than  the  other  physio-therapeutic  methods.* 

The  visceral  musculature  is  of  the  non-striped  variety, 
which  is  more  easily  fatigued  than  striped  muscles.  Exces- 
sive stimulation  of  muscle  results  in  degeneration  of  the 
latter.  If  a  muscle  is  stimulated  by  maximum  induction- 
shocks  until  it  ceases  to  contract,  its  excitability  may  be 
restored  by  massage,  the  constant  current,  veratrin,  per- 
manganate of  potash,  or  rest. 


*The  author  has  investigated  the  Leduc  (direct  interrupted  current  of  low 
tension)  and  thermo penetrating  currents,  and  finds  them  of  no  value  in  the  elicita- 
tion  of  visceral  reflexes  by  vertebral  excitation. 

399 


Spondyloth     e     r    a    p    y 

The  foregoing  facts  may  be  illustrated  clinically  in  the 
use  of  physio-therapeutic  methods.  Thus,  if  the  visceral 
reflexes  can  no  longer  be  elicited  after  the  prolonged  use 
of  one  method  of  excitation,  another  method  may  evoke 
a  response. 

In  a  patient  with  a  large  aortic  aneurysm  every 
symptom  had  practically  yielded  in  about  two  weeks  to 
treatment  by  concussion,  excepting  a  slight  cough. 
Recourse  was  then  had  to  the  rapid  sinusoidal  current  on 
either  side  of  the  seventh  cervical  spine  and  within  a  few 
days  this  vestigial  symptom  of  the  disease  disappeared. 

An  elderly  gentleman  was  practically  moribund  on 
two  occasions  and  was  restored  to  comparative  comfort 
by  concussional  treatment.  A  slight  dyspnea  on  exertion 
with  a  rapid  pulse  persisted  despite  treatment.  Within  a 
few  days  after  daily  hypodermic  use  of  strophanthin, 
dyspnea  and  tachycardia  disappeared.  This  same  drug 
prior  to  concussional  treatment  was  ineffective.  Thus, 
drugs  must  be  employed  as  succedanea  for  physio- 
therapy and  the  latter  for  drugs. 

TROPHIC  FUNCTIONS  OF  THE  SPINAL  CORD. — Aside  from 
the  function  of  the  cord  as  a  conductor  of  impulses,  one'  must 
not  disregard  its  puissant  function  of  presiding  over  muscular, 
cutaneous,  osseous  and  arthritic  nutrition.  The  trophic 
control  is  probably  resident  in  the  gray  matter.  Lesions  of 
the  lower  motor  neurone  cause  atrophy  or  dystrophy  of  the 
muscles.  To  question  the  existence  of  trophic  nerves  is  a 
mere  matter  of  logomachy.  Suffice  it  to  say  that  the  nerve- 
cells  of  the  cord  maintain  the  normal  state  of  nutrition  of 
the  organs  and  tissues  and  implication  of  the  cells  predicates 
definite  trophic  disturbances. 

CELL-STIMULATION. — The  essential  principle  of  living 
substance  is  its  property  of  altering  its  metabolism  and 
transforming  its  energy.  This  principle  is  known  as  irrita- 
bility, and  the  agents  which  can  excite  it  (heat,  light,  electri- 

400 


The        Reflexes 

city  and  chemic  and  mechanic  agents),  are  known  as  stimuli. 
The  metabolic  change  resulting  from  stimulation  may 
develop  kinetic  energy  and  the  cellular  condition  is  known  as 
excitation,  or  potential  energy  is  developed  and  the  cellular 
condition  is  known  as  its  trophic  effect. 

Stimuli  which  may  evoke  the  former  propitious  effect 
may  also  check  metabolism  (cellular  paralysis).  The  follow- 
ing observations  on  cell-stimulation  are  axiomatic: 

1.  The   development   of   energy   is   greater   than   the 

energy  of  the  stimulus  used. 

2.  Cells  summate  the  effects  of  stimuli.    With  a  rapid 

succession  of  stimuli,  contractions  may  be  evoked 
which  are  stronger  than  that  obtained  by  a  single 
stimulus. 

3.  Cells  always  react  in  a  specific  way,  irrespective  of 

the  nature  of  the  stimulus;  a  muscle-cell  responds 
with  contraction;  the  cell  of  a  salivary  gland  will 
secrete  saliva. 

4.  Stimuli  are  transient  in  their  action  and  overstimu- 

lation  always  conduces  to  exhaustion.  I  have  italic- 
cized  the  latter  fact  to  emphasize  its  importance. 
It  applies  with  equal  cogency  to  pharmaco-,  or 
physio-therapy. 

TROPHIC  DISEASES. — There  are  a  number  of  diseases 
characterized  by  nutritional  disorders  in  which  the  lesion 
is  probably  resident  in  the  gray  matter  of  the  cord  or  in  the 
peripheral  nerves  (which  comprise  the  lower  motor  neurons 
presiding  over  nutrition).  The  trophic  impulses  usually 
traverse  the  motor  nerves.  It  is  only  necessary  to  mention 
several  trophic  diseases  in  which  I  have  employed  concussion 
as  a  mechanic  aid  to  cell-stimulation. 

ARTHRITIS  DEFORMANS.*— This  disease  is  recognized  by 
the  following: 

*This  affection  is  likewise  discussed  on  page  105. 

401 


Spondyloth     e     r    a    p    y 

1.  Muscular  atrophy  precedes  the  involvement  of  the 
smaller  and  unusual  joints  (maxillary  articulation,  fingers, 
toes). 

2.  Presence  of  trophic  or  pigmentary  lesions  in  juxta- 
position to  the  implicated  joints  and  stiffness  or  soreness 
antedating  the  actual  inflammatory  changes. 

3.  Persistence  of  the  condition  when  a  joint  is  once 
attacked. 

4.  The  negative  action  of  the  salicylates  (page  142),  and 
the  infrequency  of  endo  or  pericarditis  excludes  rheumatism. 

5.  Gout  is  excluded  by  the  absence  of  movable  deposits 
of  sodium  urate  in  the  soft  parts  beneath  the  skin.    In  the 
monarticular    form    of    arthritis    deformans,    large   joints 
(shoulder,  hip,  knee),  may  be  involved.     When   the  hip  is 
involved,  it  corresponds  to  the  condition  known  as  morbus 
coxae  senilis. 

It  is  usual  to  regard  arthritis  deformans  as  a  chronic 
infection,  an  hypothesis  which  has  supplanted  the  view  once 
held  that  it  was  associated  with  lesions  of  the  spinal  cord. 
In  accordance  with  this  theory,  I  have  employed  concussion 
of  definite  vertebrae.  While  my  results  have  not  been 
phenomenal  and  I  have  not  restored  the  shape  of  crippled 
joints,  pains  were  subdued,  a  modicum  of  function  was 
restored  to  the  joints  and  I  believe  the  progress  of  the  disease 
was  arrested. 

In  1831,  Prof.  K.  Mitchell,  associated  this  affection  with 
lesions  of  the  ganglion-cells  of  the  anterior  horns  (congestion) 
and  he  successfully  treated  this  and  chronic  forms  of  rheu- 
matism by  cupping  and  blistering.  From  8  to  16  ounces  of 
blood  were  abstracted  from  the  regions  corresponding  to 
the  cervical  (upper  extremities  affected,)  or  lumbar  enlarge- 
ments (lower  extremities  affected).  When  cupping  was 
unsuccessful,  blistering  was  employed  in  the  same  regions. 

402 


The        Reflexes 

Latham80,  and  others,  have  recently  reported  brilliant 
results  in  hopeless  cases  following  thorough  and  repeated 
blistering. 

Freezing,  in  my  experience,  is  more  efficient  and  less 
troublesome  than  blistering.  Unless  the  results  are  immed- 
iate (less  pain  and  stiffness),  nothing  can  be  expected  from 
repetition  of  the  treatment.  When  the  upper  extremities  are 
involved,  one  should  freeze  in  the  region  of  the  cervical 
enlargement  of  the  cord  (3d  cervical  to  2d  dorsal  vertebra), 
and  to  influence  the  lower  extremities,  the  entire  region  cor- 
responding to  the  lumbar  enlargement  (gth  dorsal  to  ist 
lumbar  vertebra)  should  be  frozen. 

The  employment  of  dry  hot  air  in  this  disease  has  been 
highly  commended  by  a  number  of  observers.  However,  to 
be  efficient,  the  air  must  attain  a  temperature  of  from  350° 
to  400°  F.  A  lower  temperature  gives  indifferent  results. 

Thermotherapy  is  often  discredited  for  the  reason  that 
the  amount  of  heat  applied  to  a  part  is  insufficient.  The 
fact  of  the  matter  is  that  as  long  as  the  peripheral  circulation 
is  maintained,  neither  extreme  heat  nor  cold  shows  pene- 
trating power  of  sufficient  practical  value.  The  latter  objec- 
tion I  have  often  obviated  by  making  an  extremity  anemic  by 
aid  of  a  rubber  bandage. 

When  a  multiplicity  of  remedies  are  recommended  for 
an  individual  disease,  it  is  less  a  reproach  to  physiologic 
pharmacology  than  it  is  to  pathology.  The  latter,  for  many 
diseases,  is  not  definitely  established  and  it  varies  according 
to  the  stage  of  the  disease  and  the  reaction  of  the  individual. 

Among  the  physio-therapeutic  methods  which  have 
recently  enjoyed  therapeutic  renomee  in  the  treatment  of 
arthritis  deformans  and  other  affections,  is  thermopenetra- 
tion. 

Insomuch  as  the  latter  has  given  excellent  results  accord- 

403 


Spondyloth     e    r    a    p    y 

ing  to  a  method  original  with  myself,  I  shall  give  it  special 
consideration. 

DIATHERMIC  SPONDYLOTHERAPY. — The  local  application 
of  heat  has  always  been  recognized  as  a  valuable  empiric 
method  of  treatment. 

The  physiologic  action  of  heat  is  produced  by  irritation 
of  the  cutaneous  nerve-endings  manifested  by  dilation  of 
the  blood-vessels,  augmented  functionation  of  the  sweat- 
glands  with  increased  local  elimination,  improved  nutrition 
of  the  tissues  and  changes  in  the  cellular  metabolism  resulting 
from  the  increased  temperature  of  the  part. 

Perhaps  the  most  important  physiologic  action  of  heat 
is  to  produce  hyperemia.  The  latter  is  nature's  own  remedy 
and  occurs  with  the  regularity  of  a  natural  law. 

Among  the  effects  of  hyperemia  are:  Relief  of  pain, 
bactericidal  action,  resorption  property  of  dissolving  blood- 
coagula,  exudates  in  joints  and  tendons,  etc. 

Heretofore,  the  different  methods  employed  for  raising 
the  temperature  of  the  subcutaneous  tissues  suffered  the 
drawback  of  injuring  the  skin.  The  latter  is  a  very  poor 
conductor  of  heat  and  investigations  show  that  it  is  practically 
impossible  to  raise  the  temperatures  of  the  subcutaneous 
structures  by  the  conventional  methods  of  using  heat  to  the 
skin. 

It  has  been  found  that  a  high  potential  oscillating  current 
passing  into  the  body  over  a  small  cross-section  generates 
heat  in  the  tissues  in  inverse  proportion  to  the  conductivity 
of  the  structures. 

It  has  been  demonstrated  that  when  the  electrodes  from 
an  efficient  high-frequency  current  are  placed  upon  the 
flanks  of  a  guinea-pig,  whose  temperature  was  100.6°  F.,  in 
about  three  minutes  the  temperature  in  the  rectum  was 
raised  to  108°  F.  The  method  for  raising  the  temperature 

404 


The        Reflexes 

of  the  subcutaneous  structures  is  known  as  diathermy,  trans- 
thermy  and  thermo-penetration.  In  the  conventional  use 
of  diathermy,  notably  in  affections  of  the  joints,  the  electrodes 
are  applied  opposite  each  other  and  the  current  is  used  to 
the  point  of  toleration  as  long  as  possible.  The  high-fre- 
quency current  for  diathermic  purposes  is  devoid  of  chemic 
action  provided  sparking  is  prevented. 

In  my  experience,  the  heat  generated  by  the  current  is  so 
great  that  patients  can  only  tolerate  it  for  a  very  limited 
period  of  time.  To  obviate  the  latter  objection,  the  sponge 
contacts  are  immersed  previous  to  application  in  a  saturated 
solution  of  ammonium  nitrate. 

Applied  directly  to  the  affected  joints  in  arthritis  de- 
formans,  there  is  a  local  reaction  manifested  by  swelling, 
pain  and  stiffness  of  the  joint.  This  reaction  is  less  accentu- 
ated with  repetition  of  the  treatment,  which,  if  successful, 
yields  results  after  a  few  seances. 

Better  results  in  my  experience,  however,  follow  the  use 
of  diathermy  to  definite  vertebral  areas. 

As  a  rule,  one  finds  sensitive  vertebral  areas  on  pressure 
corresponding  to  the  joints  involved  and  the  electrodes  are 
then  applied  on  both  sides  of  the  spine. 

LOCOMOTOR  ATAXIA. — The  exact  seat  of  the  initial  lesion 
in  tabes  is  dubitable  but  there  is  every  reason  to  believe  that 
it  is  primarily  an  inflammation  of  the  posterior  nerve-roots  or 
the  ganglion-cells  in  the  posterior  ganglia  are  first  implicated. 
In  my  experience,  diathermy  is  practically  a  specific  for  the 
characteristic  pains  of  this  disease  which  follow  dorsal  root- 
areas. 

Figs.  92  and  93  show  the  vertebral  sites  for  the  application 
of  the  diathermic  current.  Thus,  if  the  pains  are  located 
below  the  knees,  the  electrodes  are  placed  on  either  side  of 
the  spinal  column  corresponding  to  the  nth  and  i2th  dorsal 

405 


Spondyloth     e    r    a    p    y 

spines.  The  same  method  is  applicable  in  pains  of  spinal 
origin  which  prove  refractor}'  to  conventional  treatment. 
Here,  the  morbid  anatomy  is  practically  identical  with  early 
tabes,  viz.,  a  radicular  meningitis. 

THE  FUNCTIONAL  SPINE.81 — In  this  condition,  diathermy 
is  also  very  effective.  In  the  functional  spine,  pain  is  felt  in 
the  region  of  the  lower  dorsal  and  upper  lumbar  spine.  It 
is  in  the  nature  of  an  ache  and  stiffness  on  attempting  to 
straighten  up  from  a  stooping  posture  or  in  getting  up  in  the 
morning.  Limitation  of  motion  is  caused  by  muscular 
spasm. 

DISEASES  OF  THE  MOTOR  TRACT. — Atrophic  change  in 
the  motor  neurons  is  the  basic  anatomic  lesion  in  these 
diseases  and  concussional  treatment  should  be  given  a  trial. 
In  one  case  of  Polio-Myelitis,  in  which  both  legs  were 
affected  and  the  paralysis  had  failed  to  yield  to  conventional 
treatment,  an  almost  complete  cure  was  effected  by  vertebral 
concussion.  The  affected  muscles  began  to  react  to  the  in- 
duced current  after  twelve  seances* 

If  the  lower  extremities  are  implicated,  concussion  is 
executed  in  the  region  corresponding  to  the  lumbar  enlarge- 
ment (gth  dorsal  to  ist  lumbar  vertebra). 

BERI-BERI. — This  disease,  which  is  very  prevalent  in 
tropical  countries,  is  characterized  by  motor  and  sensory 
paralysis  and  atrophy  of  the  muscles.  Among  the  clinical 
forms  of  the  disease,  there  is  the  acute  cardiac  form  asso- 
ciated with  symptoms  of  cardiac  failure.  Dr.  George  Day- 
wait  has  forwarded  me  the  following  report  concerning  the 
treatment  of  beri-beri  by  aid  of  vertebral  concussion. 

*In  the  examination  of  a  child  with  a  disabled  limb  in  this  disease,  it  is  well  to 
remember  that  when  the  child  is  suspended  in  a  warm  bath,  better  movements 
can  be  made;  hence,  this  method  gives  a  clearer  picture  of  the  degree  of  impairment, 
and  facilitates  treatment  by  enabling  the  child  to  exercise  the  limb  which  would 
otherwise  be  impossible. 

406 


The        R      e      f     I      e      x      e 

U.  S.  A.  T.  "Seward," 
MANILA,  P.  I.,  May  7,  1910. 

"In  answer  to  your  letter  of  inquiry  concerning  my 
experience  in  the  treatment  of  chronic  beri-beri,  it  gives 
me  pleasure  to  inform  you  that  remarkable  results  have 
been  obtained  by  means  of  a  series  of  concussions,  made 
by  the  strokes  of  a  rubber-tipped  hammer,  weighing 
about  one  ounce,  on  both  sides  of  the  spinal  column, 
over  the  exit  of  the  nerves  supplying  the  parts  of  the 
body  diseased.*  The  exact  technique  used  is  that  des- 
cribed in  your  monograph,  "The  Treatment  of  Aneurysm 
by  Spinal  Concussion." 

For  a  weak  heart,  concuss  the  nerve  at  its  exit  from 
the  third  dorsal;  to  affect  the  muscles  above  the  knee, 
and  calf  of  legs,  concuss  the  nerves  at  their  exit  from  the 
third  and  fourth  dorsal,  those  of  the  plantar  muscles,  the 
nerves  from  the  fourth  sacral.  As  the  hammer  falls 
gently  over  the  nerves  near  their  exit  from  the  spinal 
column,  a  play  of  the  muscles  may  be  seen  successively, 
as  each  group  is  concussed. 

The  patient  arises  from  the  seance  with  a  sense  of  re- 
newed strength  in  the  use  of  the  muscles,  which  here- 
tofore had  failed  him  in  walking. 

There  is  improvement  from  the  first  treatment. 
Each  treatment  lasts  about  five  minutes,  and  is  given 
daily  for  five  to  twenty  days.  There  is  often  some  trouble 
in  locating  the  nerve.  Make  exploratory  taps  and,  when 
the  expected  reflex  action  shown  by  the  contracting 
muscle  is  seen,  it  is  well  to  mark  the  spot  by  a  point  of 
indelible  ink.f  Locate  all  the  nerves  it  is  desired  to 
concuss;  this  having  been  done,  dismiss  the  patient 
to  return  the  next  day. 

At  the  second  and  subsequent  sittings,  let  the  hammer 
play  over  each  nerve — guided  by  the  ink-spots;  on 
first  one  and  then  the  opposite  side  of  the  column,  going 
up  and  down  the  column  much  as  the  fingers  of  the 

*Vide  Fig.  2. 

fCarbol  fuchsin  is  better  for  dermography 

407 


Spondyloth     e     r    a    p    y 

piano  player  following  the  scale  on  the  white  and  black 
key-boards.  Tap  with  the  hammer  gently,  with  just 
sufficient  force  to  cause  the  muscles  to  respond. 

My  experience  has  been  limited  to  six  cases.  The 
first,  a  man  37  years,  had  beri-beri  five  years  previously. 
Ever  since  his  recovery  from  the  acute  symptoms  he  had 
not  been  capable  of  continued  exertions  for  more  than  a 
few  minutes  without  feeling  a  fainting  sensation.  The 
only  organic  trouble  discernible  was  a  distinct  hemic 
murmur  of  the  heart.  He  had  taken  the  usual  tonics 
with  but  little  effect.  I  proceeded  to  concuss  the  nerves 
on  both  sides  of  the  spinal  column  only  opposite  the  third 
dorsal  vertebra.  The  effect  was  beneficial.  After  the 
seventh  sitting  he  declared  himself  well.  His  hemoglobin 
count  had  risen  from  60  to  80.  I  saw  him  a  month  later, 
the  picture  of  health  and  no  murmur  noticeable. 

The  third  case  was  a  soldier,  22  years  old,  who  had 
beri-beri  eighteen  months  previously,  was  returned  to 
duty  after  a  month  in  the  hospital  but  was  unable  ever 
to  do  full  duty.  When  I  saw  him  his  captain  had  just 
forwarded  a  request  for  his  discharge.  He  could  not 
make  more  than  two  or  three  hundred  yards  without 
"falling  out,"  because  of  weakness  of  his  knees,  legs  and 
feet.  Treatment  was  begun  at  once  with  the  result  that 
within  two  months  he  was  doing  full  duty,  even  to  scaling 
a  1 2 -foot  wall.  In  not  one  of  the  six  cases  was  any 
medicine  used.  Good  hygiene  and  proper  food  were  the 
only  synergists  used.  In  one  only,  the  heart  symptoms 
predominated.  The  other  five  had  the  lower  extremities 
affected,  and  of  these  five,  three  were  cured,  the  other 
two  markedly  improved. 

Wishing  you  every  success  in  your  pioneer  work 
to  make  scientific  the  treatment  of  chronic  and  heretofore 
incurable  affections  resulting  from  apathetic  conditions 
of  the  nervous  system, 

I  remain  very  sincerely, 
G.  W.  DAYWALT, 

ist  Lt.  Med.  Res.  Corps,  U.  S.  A. 

408 


The        Reflexes 

Beri-beri  is  essentially  a  multiple  neuritis  and  concussion 
is  indicated  in  the  latter  disease  after  the  acute  symptoms 
have  subsided. 

THERAPEUTIC-PHYSIOLOGY  or  CONCUSSION.* — Numer- 
ous correspondents  have  solicited  further  information  con- 
cerning this  subject.  What  is  said  of  concussion  refers  with 
equal  cogency  to  other  methods  for  eliciting  the  visceral 
reflexes  and,  if  aneurysm  is  selected  as  a  paradigm,  it  is 
because  it  has  been  made  the  subject  of  the  most  frequent 
interrogation. 

The  balneologic  treatment  of  heart-disease  by  Nauheim 
baths  has  shown  itself  to  be  of  great  value  and  is  based  on 
sound  physiologic  principles.  Schott,  who  inaugurated  this 
treatment  suggested  among  other  things,  that  the  good 
results  were  due  to  a  reflex  stimulation  of  the  heart  which 
evokes  slower  and  more  powerful  contractions  of  the  organ. 
In  other  words,  one  elicits  by  this  method  the  heart  reflex 
as  suggested  on  page  218. 

MUSCLE  TONUS  refers  to  a  continuous  (however  slight) 
contraction  of  muscle  under  normal  conditions  and  which  is 
maintained  by  subminimal  nerve-impulses  constantly  dis- 
charged from  nerve-centers  into  the  muscles.  In  this  way, 
the  neuro-muscular  apparatus  is  in  a  condition  of  tonic 
activity.  Thus,  the  sphincters  in  the  norm  are  in  a  state  of 
tonic  contraction.  Tonus  is  of  the  greatest  importance  in 
clinical  medicine  as  we  shall  learn  in  chapter  XIII.  It 
is  most  probably  maintained  by  the  direct  stimulating  effect 
of  the  internal  secretions  upon  the  peripheral  organs  or 
upon  the  central  or  peripheral  nerve-cells. 

That  tonus  may  be  augmented  from  the  periphery  is 
illustrated  when  the  skin  becomes  chilled.  Here,  the  sensory 
stimulation  thus  evoked,  reacts  upon  the  nerve-centers  and 

*Reference  has  already  been  made  to  this  subject  on  page  267. 

409 


S  p    o    n    d    y    I    o    t    h     e    r    a    p    y 

the  discharge  along  the  motor  paths  to  the  muscles  causes 
the  discernible  movements  of  shivering. 

It  is  in  this  way  that  one  may  explain  the  elicitation  of 
visceral  reflexes  either  by  peripheral  or  central  stimulation 
(vertebral  reflexes).  We  shall  als.o  learn  in  chapter  XIII 
that  tonus  may  be  influenced  by  psychic  factors.  Let  us 
in  our  polemic  concede  that  the  foregoing  holds  as  far  as 
musculature  is  concerned.  In  the  aorta,  however,  the 
tunica  media  (middle-coat),  in  comparison  with  the  coat  of 
other  arteries,  is  thicker  and  contains  relatively  more  elastic 
and  less  muscular  tissue.  In  the  root  of  the  aorta,  this  coat 
consists  chiefly  of  striated  muscle  (like  that  of  the  pulmonary 
artery),  and  resembles  that  of  the  myocardium  with  which 
it  is  continuous. 

The  contractility  of  the  aorta,  however,  is  a  question  of 
physiology  and  not  histology. 

The  majority  of  writers  contend  that  mesarteritis  result- 
ing in  degeneration  of  the  elastic  tissue  of  the  aorta  is  the 
predisposing  cause  of  aneurysms.* 

Experimental  aneurysms  result  when  the  wall  of  an 
artery  is  cauterized;  the  resulting  inflammation  causing  the 
formation  of  fibrous  tissue  without  elasticity  and  the  latter 
being  less  resistant  than  an  elastic  tube,  dilatation  of  the 
vessel  ensues. 

In  small  sacculated  aneurysms,  a  spontaneous  cure  has 
been  known  to  occur  by  thrombosis.  In  our  many  successful 
symptomatic  cures  of  aneurysms,  we  have  not  had  an  oppor- 
tunity of  determining  the  role  played  by  thrombosis,  hence 
the  doctrinaire  must  await  the  verdict  of  the  necropsy.  We 
believe  that  our  results  are  achieved  by  increasing  the 
tonicity  of  the  vagus  (vide  chapter  XIII),  which  in  reacting 
on  the  fibro-muscular  coat  of  the  aorta  diminishes  the 

*As  will  be  shown  on  page  552,  the  author  is  not  in  accord  with  this  view-point. 

410 


The        Reflexes 

caliber  of  the  vessel  and  by  augmenting  its  elasticity  makes 
it  more  resistant  (Fig.  119).  The  results  attained  are  not 
unlike  the  effects  on  the  heart  by  the  methods  of  Schott. 
The  physiologic  excitation  of  the  aortic  and  other  visceral 
reflexes  increases  the  contractility  and  tonicity  of  the  aorta 
and  viscera  but  when  the  stimulation  is  excessive,  the 
opposite  effect  is  produced,  viz. :  dilatation  and  diminished 
contractility  and  tonicity. 

PERIPHERAL  REFLEX  PHENOMENA  OF  VISCERAL  DISEASE. 

i.  Pain;  2.  Hyperalgesia;  3.  Muscular  Spasm;  4. 
Secretory  reflexes;  5.  Vasomotor  reflexes ;  6.  Pilo-motor 
reflexes;  7.  Paravertebral  tenderness;  8.  Elevation  of 
temperature. 

Before  consideration  is  given  to  the  foregoing  symp- 
toms attention  must  be  directed  to  the  cerebro-spinal  and 
to  the  autonomic-nervous  system*  (page  24).  The  former 
system  including  the  brain,  spinal  cord  and  the  peri- 
pheral nerves  mediates  sensation  and  muscular  contrac- 
tion. 

The  autonomic  system  innervates  the  viscera. 

Both  systems  are  intimately  associated  and  afferent 
impulses  passing  from  the  viscera  stimulate  the  nerves 
of  the  cerebro-spinal  system  so  as  to  eventuate  in  peri- 
pheral pain,  hyperalgesia  and  muscular  spasm.  The 
autonomic  system,  according  to  Langley,  is  shown  in 
Fig.  101. 


*Further  discussed  in  Chapter  XIII. 

m 


S  p    o     n     d    y    I    o     t    h 


a    p    y 


Sphincter  of  iris.  ( 
Ciliary  muscle.     I    *  * 

Dilator  of  iris.     Orbital  muscle. 

Heart.  Blood-vessels  of  mucous 
membrane  of  "head. 

Walls  of  gut  from  mouth  to  de- 
scending colon. 

Outgrowths  from  this  region  of  the 
gut  (muscle  of  trachea  and 
lungs  ;  gastric  glands,  liver, 
pancreas). 


The  skin  (arteries,  muscles,  glands). 

Blood-vessels  of  gut  between 
mouth  and  rectum,  of  lungs 
and  of  abdominal  viscera. 

Arteries  of  skeletal  muscle. 

Muscle  of  spleen,  ureter,  and  of 
internal  generative  organs. 

Walls  of  stomach,  intestine,  gall 
bladder  and  ducts,  urinary 
bladder. 


Arteries    of    rectum,    anus    and 
external  generative  organs. 

Walls  of  descending  colon  to  end 
of  gut. 

Walls  of  bladder  and  urethra. 

Muscle     of     external     generative 
organs. 


Mid-brain  autonomic. 


Bulbar  autonomic. 


Sympathetic. 
(I.  Th.  to  II.  or  III.  L.  in  man.) 


Sacral  autonomic. 
(II.  to  IV.  S.  about  in  man.) 


Fig.  101. — Illustrating  the  origin  and  distribution  of  efferent  autonomic  fibers. 
"Muscle,"  refers  to  unstriated  muscle  only  and  the  "walls"  of  a  structure  signify 
the  unstriated  muscle  in  them.  The  innervation  of  the  gastric  glands,  pancreas 
and  liver  and  the  arterioles  of  the  skeletal  muscles  and  the  central  nervous  system 
is  still  dubitable. 


412 


The        Reflexes 

i.  PAIN. — When  the  cerebro-spinal  nerves  are  stimu- 
lated, the  pain  is  referred  to  the  peripheral  distribution  of  the 
nerve.  In  many  instances,  however,  the  pain  is  not  strictly 
localized  in  the  irritated  nerve  itself  but  it  radiates  to  different 
areas. 

Mackenzie68  quotes  Sherrington,  who  states  that,  after 
applying  a  mustard  leaf  over  the  front  of  the  upper  part  of 
the  sternum,  an  unpleasant  tingling  sensation  was  exper- 
ienced above  the  inner  condyle  over  each  upper  arm.  In 
explanation  of  this  phenomenon,  one  knows  that  the  second 
thoracic  nerve  supplies  equally  the  upper  chest  and  the 
inner  side  of  the  upper  arm  and  that,  when  the  stimulus 
from  the  chest  (after  application  of  the  mustard  plaster) 
reaches  the  spinal  cord,  it  affects  the  adjacent  cells.  Hence, 
although  the  peripheral  parts  are  widely  apart,  they  have  a 
common  center  in  the  cord. 

This  overflow  of  the  reflexes,  or  what  is  currently  known 
as  radiation  of  pain,  is  illustrated  in  daily  practice  and  is 
often  a  source  of  error  in  diagnosis.  Thus,  one  may  cite 
abdominal  pain.  Palpate  the  abdomen  almost  anywhere 
and  the  pain  is  often  as  keenly  felt  in  one  as  in  another 
situation.  In  such  instances,  the  pain  without  conspicuous 
associate  symptoms  may  mean  an  appendicitis,  and  for  that 
matter,  it  may  just  as  well  be  the  pain  of  biliary  or  renal 
colic,  or  if  a  woman  be  the  subject,  pelvic  disease.  Here  the 
inhalation  of  chloroform,  not  to  the  point  of  anesthesia,  but 
just  enough  of  it  to  quiet  the  patient  without  affecting  con- 
sciousness, causes  the  disappearance  of  radiating  pains, 
*vhile  the  original  pain  remains  fixed  in  the  region  of  the 
right  hypochondrium  in  gall-stone  colic,  or  over  McBur- 
ney's  point,  in  appendicitis.  Morphin,  hypodermatically, 
accomplishes  the  same  object. 

In  this  connection,  I  wish  to  refer  to  another  diagnostic 

413 


Spondyloth     e     r    a    p    y 

point.  If  one  is  in  doubt  concerning  the  organ  as  the  source 
of  pain,  palpation  or  pressure  on  the  implicated  organ  will 
reproduce  the  exact  pain  about  which  the  patient  complains. 
A  fixed  pain  practically  always  denotes  an  organic  and  not 
a  functional  lesion. 

In  trigeminal  neuralgia,  I  have  frequently  encountered 
sensitive  areas  at  the  side  of  the  ist  and  2nd  cervical  spines, 
and  freezing  of  the  latter  was  followed  by  relief  for  a  vari- 
able period  of  time.  This  also  applies  to  odontalgia.  A 
spinal  tract  of  the  trigeminus  can  be  traced  as  far  down  as 
the  second  cervical  segment  of  the  cord.  It  is  also  easy  to 
understand  vagal-reflexes  in  consequence  of  trigeminal  irri- 
tation; at  its  cranial  end,  the  vagus  is  in  direct  relation  with 
the  trigeminus  through  the  intervention  of  the  tubercle  of 
Rolando. 

Even  under  anesthesia,  the  trigeminus  maintains  its 
sensibility  and  though  sensation  is  abolished  elsewhere^ 
punctures  in  the  temples  and  frontal  region  are  still  per- 
ceived. 

Dr.  Geo.  Baert,  of  Michigan,  having  availed  himself  of 
the  foot-note  suggestion  on  page  374,  employed  the  treat- 
ment successfully  in  several  cases  of  trigeminal  neuralgia, 
notwithstanding  futile  results  with  injections  of  alcohol. 

An  overflow  of  the  reflexes  is  frequently  noted  in  func- 
tional disturbances.  Thus  in  hysterical  anesthesia,  there  is 
a  temporary  restoration  of  cutaneous  sensibility  after  the 
use  of  morphin  hypodermatically.  In  hysteria,  one  also 
observes  during  the  stage  of  chloroform  excitation,  the  dis- 
appearance of  contractures  and  other  stigmata  of  the  disease. 
One  must  not  forget  that  spinal  nerves  are  composite 
structures  and  spasm  and  pain  are  associated  with  their 
irritation.  Thus,  in  laryngeal  stenosis  of  children,  the  use  of 
an  opiate  excludes  the  spasmodic  element  and  often  makes 

414 


Visceral       Pa 


n 


a  tracheotomy  unnecessary.  This  same  practice  applies  to 
the  introduction  of  an  instrument  into  the  bladder  when 
there  is  spasm  of  the  vesical  sphincter. 

VISCERAL  PAIN.* — Mackenzie  contends  that  the  viscera 
are  insensitive  to  ordinary  stimulation  and  what  is  regarded 
as  visceral  sensitiveness  by  the  examining  physician  is  merely 
cutaneous  and  muscular  hyperalgesia.  In  other  words, 
visceral  pains  are  not  felt  in  the  organ,  "but  are  referred  to 
the  peripheral  distribution  of  cerebro-spinal  nerves  in  the 
external  body-wall."  In  support  of  his  hypothesis,  Mac- 
kenzie cites  the  following: 

1.  Pressure  exerted  over  a  supposed  gastric  ulcer,  an 
enlarged  liver,  or  an  inflamed  pleura,  causes  pain;  but  this 
method  of  investigation  ignores  the  augmented  sensibility 
(hyperalgesia)  of  the  tissues  (skin  and  muscles)  covering  the 
external  body- wall.  . 

2.  Pain  is  felt  in  the  position  where  the  organ  is  situated. 
If  this  were  true,  then  the  pain  would  shift  in  accordance 
with  the  location  of  the  organ.    Thus,  in  gastric  ulcer  even 
though  the  stomach  is  dislocated  by  deep  respiratory  move- 
ments, the  pain  remains  stationary.          . 

I  contend  that  there  is  visceral  pain  sui  generis  but  that, 
it  may  be  associated  with  pain  referred  to  the  coverings  of 
the  body-wall  connected  with  the  same  segments  of  the 
spine.  The  investigations  of  Mackenzie  demonstrate  that 
the  viscera  are  only  insensitive  to  such  stimuli  as  pressing, 
drying,  application  of  silver-nitrate,  burning,  cutting,  etc., 
and  that,  were  a  definite  stimulus  employed,  visceral  sensi- 
tiveness could  be  shown.  It  is  known  that  a  nerve-ending 
may  respond  to  one  form  of  stimulation  and  yet  prove 
insensitive  to  others.  Every  nerve  when  stimulated  responds 

*Reference  is  made  to  this  subject  on  pages  58  and  413. 

415 


Spondylotherapy 

in  a  manner  peculiar  to  its  function.  Stimulation  of  the 
optic  nerve  creates  the  sensation  of  light  and  excitation  of 
the  auditory  nerve  responds  with  the  sensation  of  sound. 
The  recent  investigations  of  Hertz69  show  that  tension  is  the 
only  cause  of  true  visceral  pain  and  that  pain  originating 
in  the  peritoneum*  is  not  uncommon  in  the  absence  of 
visceral  pain. 

In  a  patient  where  the  diagnosis  of  gastric  ulcer  was 
definitely  established,  the  skin  and  muscle  in  the  region  of 
a  sensitive  point  were  anesthetized  yet,  by  deep  pressure, 
I  succeeded  in  eliciting  the  same  degree  of  tenderness  as 
before  local  anesthesia. 

By  my  method  of  transmitted  palpation  (page  83),  vis- 
ceral sensitiveness  is  easily  demonstrated.  By  aid  of  the 
vertebral  reflexes  (page  7),  visceral  pain  may  be  accentuated 
or  inhibited  and  the  same  holds  good  for  segmental  analgesia 
of  the  viscera  (page  376). 

The  local  area  of  tenderness  of  visceral  origin  does  shift 
when  the  vertebral  reflexes  are  employed  (Fig.  85). 

2.  HYPERALGESIA. — Cutaneous  hyperalgesia  consecu- 
tive to  visceral  disease  has  already  been  discussed  (page  58). 

Hyperalgesia  of  other  structures,  notably  the  muscles,  is 
equally  common.  Pressure,  to  elicit  muscular  hyperalgesia 
is  faulty,  for  the  reason  that  one  cannot  exclude  cutaneous 
hyperalgesia.  Here,  one  may  make  passive  movements,  or 
the  muscular  tenderness  may  be  evoked  by  active  move- 
ments of  the  muscles  by  the  patient.  When  the  muscular 
hyperalgesia  is  associated  with  spasm,  mistakes  in  diagnosis 
are.  not  infrequent  (page  191). 

*Lennander,  contended  that  the  parietal  peritoneum  is  intensely  sensitive  to 
pain,  but  not  to  pressure,  heat,  or  cold  and  that  painful  abdominal  sensations  are 
transmitted  by  the  phrenic,  lower  six  intercostals,  lumbar  and  sacral  nerves  (which 
innervate  the  parietal  peritoneum).  The  visceral  peritoneum  and  abdominal 
organs  (innervated  by  vagus  or  sympathetic),  are  not  sensitive  to  pain. 

416 


M    u    s    c    u    I    a    r      Spasms 

3.  MUSCULAR  SPASMS.* — The  term,  viscera-motor  reflex 
has  been  applied  to  the  spasm  of  a  muscle  in  consequence  of 
visceral  disease.  This  reflex  is  commonly  observed  in  affec- 
tions of  the  abdominal  viscera  (hardness  of  the  abdominal 
muscles  and  tenderness  which  are  accentuated  by  palpation). 
Muscular  spasm  as  a  peripheral  symptom  of  visceral  disease, 
may  be  manifested  by  clonic  or  tonic  contraction  and  involve- 
ment of  a  part  or  the  whole  of  a  muscle.  When  the  part  of 
a  muscle  is  involved,  it  may  be  mistaken  for  a  tumor  (page 
191).  In  some  instances,  the  viscero-motor  reflex  in  question 
is  only  recognized  by  increased  resistance  on  palpation. 

Muscular  spasms  may  persist  during  deep  narcosis  and 
as  a  rule,  they  yield  last  of  all  the  muscles  during  anesthesia. 

Dr.  C.  A.  Reed  7°,  based  on  the  observations  of 
Nothnagel  and  Lennander,  who  insist  that  visceral  pain 
is  only  a  phenomenon  of  muscular  hyperalgesia,  seeks 
by  subduing  the  latter  to  relieve  visceral  pain.  Many 
post-operative  pains  following  operations  on  the  uterus 
and  adnexa  have  been  subdued  (even  though  morphin 
failed),  by  deep  muscular  injections  of  the  following 
solution  into  the  hyperalgetic  areas: 

1$  gm.  or  c.c. 

Morphin  hydrochloric! o|oi 

Novocain o  1 04 

or 

Scopolamin 0(0015 

Normal  salt  solution 1 1 

"This  represents  a  single  dose  which,  before  adminis- 
tration, is  further  diluted  with  physiologic  salt  solution 
to  permit  of  its  distribution  by  numerous  deep  punctures 
with  an  ordinary  hypodermatic  needle  into  the  hyperal- 
getic areas. 

2.     For   analgesia,    after   thoroughly   cleansing   the 
integument,  all  of  the  mixture  is  injected  into  the  muscular 

*Vide  page  46,  et  seq. 

417 


S  p    o    n    d    y    I    o    t    h     e    r    a    p    y 

layer,  several  punctures  being  employed  and  care  being 
taken  to  make  them  at  points  that  approximately  define 
the  circumference  of  the  hyperalgetic  area.  The  anal- 
getic effects  will  be  realized  within  from  five  to  ten 
minutes,  and  in  consequence  of  the  presence  of  the 
scopolamin,  will  be  continued  often  from  six  to  eight 
hours,  while  in  some  instances  they  will  be  permanent. 
3.  For  local  anesthesia,  the  same  solution  is  used  in 
the  same  way,  with  the  exception  that  it  is  discharged  into 
the  subcutaneous  connective  tissue  at  points  that  approxi- 
mately define  the  circumference  of  the  area  that  it  is 
desired  to  anesthetize.  The  sensibility  will  disappear  in 
from  five  to  eight  minutes  and  will  remain  absent  for 
a  period  varying  from  an  hour  to  three  hours." 

Reed  argues  that,  if  an  algetic  impulse  can  be  telegraphed 
from  viscus  to  muscle,  an  analgetic  impulse  can  be  trans- 
mitted from  muscle  to  viscus  and  thus  pain  may  be  con- 
trolled. It  is  true  that  we  know  little  of  autonomic  phenom- 
ena and  are  not  sure  of  that  but  it  is  reasonable  to  assume 
that  the  analgesic  formula  before  mentioned  owes  its 
efficacy  to  its  action  on  the  sensory  nerves  of  the  muscle. 

It  is  known  that  an  inflamed  joint  may  be  absolutely 
fixed  in  consequence  of  powerful  contractions  of  the  sur- 
rounding musculature.  This  condition  may  suggest  a  false 
ankylosis  and  insomuch  as  the  muscular  spasm  may  persist 
even  during  narcosis,  I  would  suggest  the  use  of  Reed's 
formula  for  releasing  the  spasm  and  thus  aiding  diagnosis. 

The  author  recalls  circumscribed  spasms  of  the  sterno- 
mastoid  muscle,  which  were  mistaken  for  tumors  and  which 
were  dispersed  by  a  few  applications  of  the  Faradic  current. 
Mitchell  reported  a  phantom  tumor  in  the  left  pectoral 
region. 

Despite  the  irrelevancy  of  the  interpolation,  I  wish  to 
direct  attention  to  circumscribed  tonic  spasms  of  the  visceral 

418 


Muscular     Spasms 

musculature.  It  is  known  that  phantom  tumors  of  the 
abdomen  may  be  caused  either  by  a  contraction  of  the 
abdominal  muscles  or  meteorism,  and  when  such  tumors 
occupy  the  lower  abdomen,  they  simulate  pregnancy  (pseu- 
docyesis).  Anesthesia  may  be  necessary  to  cause  their 
disappearance.  To  my  knowledge,  no  reference  has  been 
made  to  circumscribed  tumors  of  the  uterus  mistaken  for 
fibroids  and  often  due,  as  I  believe,  to  subinvolution  of  the 
uterus.  These  pseudo-fibromata  may  be  dispersed  by  elici- 
tation  of  the  uterus  reflex,  (page  358). 

Dr.  M.  Turnbull  reports  the  following  case: 

"Patient  suffers  from  menorrhagia  and  profuse  metrorr- 
hagia.  She  is  very  pale,  emaciated  and  growing  pro- 
gressively weaker.  Examination  of  the  blood  shows  a 
profound  anemia.  Has  been  advised  by  several  promi- 
nent gynecologists  to  have  a  myomectomy  or  a  hysterec- 
tomy performed.  All  concurred  in  the  diagnosis  of  an. 
interstitial  fibroid.  Uterus  is  enlarged  and  a.  fibroma?  is 
distinctly  palpable.  Treatment  consisted  of  eliciting  the 
uterus  reflex  by  application  of  the  interrupted  sinusoidal 
current  to  either  side  of  the  second  lumbar  spine  every  day 
for  a  period  of  three  minutes.  At  the  first  treatment,  one 
could  observe  contractions  of  the  uterus  through  the 
speculum  and  the  expulsion  of  clots  of  blood  from  the 
uterus.  After  about  three  weeks  treatment,  patient 
was  practically  cured  and  has  continued  so  up  to  the 
present  time  of  writing.  Examination  shows  a  normal 
uterus  and  the  supposititious  fibroid  can  no  longer  be 
palpated.  The  patient  has  been  cured  of  a  chronic 
constipation." 

(Comment  by  the  author. — The  patient  suffered  from 
atonic  constipation  (page  328),  and  the  treatment  directed 
toward  elicitation  of  the  uterus  reflex  was  equally  appli- 
cable in  this  form  of  constipation.  Electricity  (Galvan- 
ism) has  been  credited  with  a  selective  effect  (electro- 
chemic)  on  fibroids.  It  is  probable  that  the  action  is  due 

419 


Spondyloth     e    r    a    p    y 

to  dispersion  of  irregular  contractions  of  the  uterine 
musculature) . 

ABNORMAL  POSITIONS  OF  THE  UTERUS,  caused  by  relaxed 
ligaments,  may  be  improved  and  cured  by  eliciting  the 
uterus  reflex.  Some  of  the  ligaments  contain  non-striped 
muscular  fibers,  whereas  the  round  ligaments  consist  essen- 
tially of  muscular  tissue,  prolonged  from  the  uterus. 

SEGMENTAL  PSYCHROTHERAPY  (page  375)  is  likewise  of 
diagnostic  value  assuming  that  one  is  unable  to  palpate 
the  abdominal  viscera  owing  to  rigidity  of  the  muscles. 
Reference  to  the  table  on  page  33,  shows  the  segmental 
origin  of  innervation  and  Fig.  10,  the  spines  corresponding  to 
these  segments.  If  the  spines  are  thoroughly  frozen,  palpa- 
tion is  facilitated.  I  recall  a  case  where  taxis  was  employed 
without  result  to  reduce  an  inguinal  hernia  but  when  freezing 
was  used  in  the  manner  indicated,  reduction  was  effected. 
In  another  patient,  reduction  was  effected  by  refrigerating 
the  hernia. 

MUSCULAR  RIGIDITY  IN  THORACIC  DISEASE. — In  thor- 
acic affections,  notably,  pleurisy,  pericarditis  and  pneumonia, 
the  pain  may  be  reflected  from  the  chest  to  the  abdomen. 
The  abdominal  symptoms  are  often  so  fulminant  in  char- 
acter as  to  suggest  appendicitis,  peritonitis  or  perforation, 
and  thoracic  symptoms  are  absent  or  may  be  overlooked. 
The  abdominal  signs  consist  of  tenderness  and  rigidity  of 
the  muscles,  abdominal  pains  and  symptoms  of  collapse. 
Diagnosis  can  usually  but  not  always  be  established  by  the 
absence  of  tenderness  over  the  subjectively  painful  abdo- 
minal region  and  by  a  careful  exploration  of  the  chest.  In 
differentiation,  the  use  of  chloroform  as  suggested  on  page 
413,  may  be  used. 

Ppttenger71  and  Wolff-Eisner72  direct  attention  to  muscular 
rigidity  in  thoracic  disease.  The  latter  regards  light  touch- 

420 


Rigidity    of  the    Spinal   Muscles 

palpation  as  valuable  in  the  recognition  of  pulmonary 
affections.  Pottenger,  however,  is  entitled  to  the  greater 
credit  for  having  elucidated  this  sign.  He  describes  two  signs : 

1 .  Muscle  rigidity,  which  may  be  defined  as  a  feeling 
of    resistance    noted    on   palpating  the  muscles  which 
overlie  inflammatory  conditions  affecting  the  pulmonary 
parenchyma  or  pleura  due  to  acute  muscle  spasm  when 
the  inflammation  is  acute  and  pathological  change  in  the 
muscles  when  the  inflammation  is  chronic. 

2.  A  feeling  of  different  degrees  of  resistence  noted 
over  organs  or  parts  of  organs  of  different  density  on 
"light  touch  palpation." 

The  two  signs  are  clearly  distinct.  Muscle  rigidity 
is  confined  to  the  muscles  alone,  while  the  difference  in 
resistance  found  on  light  touch  palpation  applies  to  the 
density  of  tissues  as  found  not  only  in  the  muscles,  but  the 
deeper  organs  as  well,  and  may  be  used  in  outlining  either 
normal  organs  or  areas  of  disease  where  such  disease  pro- 
duces change  in  density  of  any  of  the  tissues  which  we 
are  able  to  palpate. 

SPASM  OF  THE  ESOPHAGUS,  notably  its  lower  end,  asso- 
ciated with  cardiospasm,  is  not  infrequently  of  reflex  origin 
and  due  to  hypertonicity  of  the  vagus  (page  452). 

RIGIDITY  OF  THE  SPINAL  MUSCLES. — This  subject  has 
already  been  discussed  on  page  46  et  seq.  There  are,  however, 
conditions  remote  from  the  site  of  the  spasm  which  are 
related  to  the  latter  and  interpreted  by  the  patient  as  back- 
ache. Such  conditions  embrace  many  affections  of  the 
lower  extremities,  specified  as  rheumatic  or  neuralgic  and 
which  owe  their  origin  to  disabilities  of  the  feet.  The  latter, 
as  offending  factors  are  frequently  ignored  because  the  reflex 
backache  is  so  far  removed  from  the  foot.  Pains,  specified 
as  sciatica  are  likewise  caused  by  some  pedal  infirmity. 
The  most  frequent  condition  represented  by  the  latter  is  the 

421 


S  p     o     n    d    y    I    o    t    h     e    r    a    p    y 

•weak-foot.  The  chief  function  of  the  foot  is  the  support  of 
body-weight,  and  the  most  characteristic  sign  of  a  weak-foot 
is  the  sensation  of  weakness,  which  soon  graduates  into 
pains  extending  to  the  knees,  hips  and  regions  of  the  back. 
The  fact  that  the  pains  are  intensified  when  the  foot  is  in 
use  and  in  damp  weather,  and  that  temporary  rest  causes  a 
remittance  of  symptoms,  often  accounts  for  the  erroneous 
diagnosis  of  rheumatism. 

One  must  also  remember  that  the  weak,  is  the  initial 
stage  of  the  flat-foot. 

A  chronic  backache  associated  with  pains  in  the  legs, 
suggesting  sciatica,  when  no  adequate  cause  is  apparent, 
may  be  caused  by  back-strain  incurred  by  an  undue  effort 
to  maintain  the  balance  of  the  body.77  The  erect  position  is 
maintained  by  tonicity  of  the  posterior  musculature  and 
forward  displacement  of  the  body  makes  an  increased 
demand  on  this  musculature  to  maintain  the  erect  position. 

Static  backache  may  also  be  due  to  varicose  veins  and  to 
intra-pelvic  disease.  In  the  latter,  there  is  an  instinctive 
tendency  to  lessen  intra-pelvic  pressure  by  change  of  attitude. 

CHRONIC  FIBROSITIS. — This  subject  has  been  partially  described 
on  page  90,  Fig.  35.  Further  reference  to  it  is  dictated  by  the  fact 
that  the  muscular  infiltrations  may  be  confounded  with  circumscribed 
tonic  contraction  of  the  muscles.  The  infiltrations  or  myistides,  may 
involve  any  voluntary  muscle  of  the  body  and  their  presence  in  the 
abdominal  muscles  may  suggest  disease  of  the  abdominal  viscera. 
Many  so-called  cases  of  chronic  articular  rheumatism  are  nought  else 
but  an  hyperplasia  of  the  periarticular  white  fibrous  tissue.  The 
myistides  are  more  painful  in  inclement  weather  and  they  may  be  so 
large  as  to  suggest  a  gumma,  notably  when  they  extend  to  the  peri- 
osteum or  fascia.  The  infiltration  may  consist  of  a  deposit  of  uric 
aoid  salts  or  allied  substances  plus  the  connective  tissue  insomuch  as 
Yawger  has  noted  after  vigorous  massage  of  the  indurations  an  attack 
of  acute  muscular  rheumatism.  I  have  frequently  observed  that 

422 


Secretory       Reflexes 

vigorous  rubbing  of  the  infiltrations  causes  them  to  swell  with  accentua- 
tion of  the  pains. 

In  addition  to  the  treatment  suggested  on  page  90,  fibrolysin  (page 
1 08),  may  be  used  by  injection  into  the  gluteal  muscles.  If  the  treat- 
ment is  effective,  the  infiltrations  and  pain  begin  to  disappear  after 
two  or  three  injections. 

The  local  application  of  salicylates  is  often  of  service.  An  ointment 
composed  of  two  drachms  of  oil  of  wintergreen  in  an  ounce  of  lanolin 
may  be  used,  or  more  costly  preparations,  known  as  mesotan  and 
anesthol. 

In  intractable  cases  of  fibrositis,  inject  into  each  infiltration  a  few 
drops  of  alcohol  (85  per  cent).  Repetition  of  the  injection  may  be 
indicated.  Disinfection  prior  to  injection  may  be  achieved  by  painting 
the  skin  with  iodin-tincture. 

Quinin  and  urea  hydrochlorid  (soluble  i  in  about  i  of  water),  may 
be  used  as  an  injection  (i  per  cent,  solution).  It  acts  as  a  local  anes- 
thetic (also  hemostatic),  and  the  effects  last  from  four  to  seven  hours. 

In  the  author's  experience,  the  most  effective  means  of  dispersing 
the  indurations  is  by  diathermy  (page  404).  The  electrodes  are  applied 
directly  over  the  infiltrations. 

I  have  frequently  found  very  circumscribed  muscular  contractions 
(suggesting  myistides),  associated  with  neuralgia  of  the  spinal 
nerves.  Freezing  at  the  vertebral  exits  of  the  affected  nerves  causes 
an  immediate  disappearance  of  the  muscular  contractions. 

4.  SECRETORY  REFLEXES. — The  reflex  center  for  the 
salivary  secretion  is  located  in  the  medulla  oblongata  in 
juxtaposition  to  the  origin  of  the  gth  and  loth  cranial  nerves. 
The  latter  may  be  stimulated  reflexly  in  visceral  diseases, 
notably  in  angina  pectoris.     The  same  reflex  effects  are 
noted  with  the  secretion  of  urine.    Thus,  one  notes  the  fre- 
quent micturition  in  appendicitis  and  the  excretion  of  large 
quantities  of  urine  after  attacks  of  visceral  pain.    In  a  num- 
ber of  instances,  the  secretory  reflexes  are  mediated  through 
the  afferent  fibers  of  the  vagus. 

5.  VASOMOTOR  REFLEXES.* — These  reflexes  are  noted 

*Vide  page  272. 

423 


Spondyloth     e     r    a    p    y 

in  individuals  in  whom  there  is  a  maladjustment  of  the  cir- 
culatory relations;  "a  tempermental  condition  of  aberrant 
motility  of  the  vasomotor  system,"  which  is  comprehen- 
sively designated  by  Cohen78  as,  vasomotor  ataxia.  The 
symptoms  of  the  latter  may  be :  i.  Constrictive ;  blanching 
or  cyanosis  of  the  skin  according  to  whether  the  venous  or 
arterial  system  is  predominantly  affected.  2.  Dilative  or 
hyperemic;  edema,  flushing  or  cyanosis  of  the  skin.  3. 
Mixed ;  the  most  common  form,  in  which  dilatation  and  con- 
striction alternate,  and  there  is  cutaneous  cyanosis,  mottling, 
blanching  and  edema.  The  foregoing  phenomena  are  not 
confined  essentially  to  the  skin  but  have  also  been  observed 
in  the  eye-grounds  and  throat. 

For  a  description  of  the  visceral  angioneuroses,  the  reader 
is  referred  to  the  original  communication  of  Solomon  Solis 
Cohen78. 

The  vasomotor  temperament,  if  one  may  be  permitted  to  so  call  it, 
may  be  recognized  by  the  following  signs: 

SKIN. — Marbled  or  mottled  skin,  intensified  by  cold  and  diminished 
by  heat.  The  cutaneous  signs  may  be  limited  to  a  definite  region  of 
the  body.  The  hands  may  assume  almost  any  color  but  usually  the 
latter  runs  out  upon  raising  the  limb  and  upon  resumption  of  the 
natural  position,  it  becomes  pink  and  then  passes  into  purple  and  blue 
tints.  Spastic  blanching  is  seen  in  the  so-called  dead  finger.  Alter- 
nations of  blanching  and  congestion  yield  the  "tattooed"  appearance 
and  blue,  red  and  white  stripes.  Pigmentation  of  the  skin,  maculated 
or  diffused,  and  transient  or  permanent,  is  observed  in  one-third  of 
the  cases.  Leucoderma  is  also  observed.  Perspiration  may  either 
be  excessive,  scanty  or  absent.  Skin-lesions  like  urticaria,  erythema 
and  eczema,  are  transient  and  recurrent.  When  the  hands  or  feet 
are  immersed  in  hot  or  cold  water,  the  responses  correspond  to  the 
norm,  although  exaggerated. 

NAILS. — In  nearly  every  case  there  is  a  deep  red  terminal  line — a 
loop  of  dilated  capillaries. 

EYES. — Widening  of  the  commissure,   tremulousness  of  the  lids 

424 


l&,  a  $  o  m  o  t  o  r      Reactions 

upon  light  closure,  dilated  pupils,  pain  in  the  eyes,  drooping  of  the 
lids,  distention  or  contraction  (less  common)  of  the  retinal  vessels. 
Among  other  symptoms  are:  Enlargement  of  the  thyroid  gland, 
irregularity  of  the  heart  and  tremor  of  the  muscles  in  some  part  of  the 
body. 

VASOMOTOR  REACTIONS. — Insufficiency  of  the  vasomotor 
apparatus  may  be  present  in  one  region  of  the  body  and 
absent  in  another.  I  have  essayed  to  elaborate  a  few  prac- 
tical reactions  which  are  of  great  value  in  diagnosis  and 
treatment.  They  refer  specially  to  the  head,  respiratory 
apparatus  and  the  splanchnic  circulation.  Only  the  latter 
will  receive  present  consideration,  reference  to  the  former 
is  made  on  page  614. 

COURSE  or  THE  VASOMOTOR  NERVES. — The  relation  of 
the  vasomotor  nerves  to  the  spinous  processes  is  discussed 
on  page  278,  but  Fig.  102,  from  Howell,  will  give  one  a  more 
comprehensive  idea  respecting  the  course  of  the  autonomic 
(sympathetic)  fibers. 

From  the  vasomotor  center,  some  of  the  fibers  pass 
directly  through  some  of  the  cranial  nerves  to  their  area  of 
distribution,  whereas  the  others,  descend  in  the  spinal  cord 
where  they  enter  into  connection  with  the  subordinate  vaso- 
motor centers  in  the  cord  and  then  leave  the  latter,  through 
the  anterior  roots  of  the  spinal  nerves  or  pass  into  the  sym- 
pathetic through  the  rami  communicantes,  from  which  point 
they  attain  the  blood-vessels  to  which  they  are  distributed. 
The  following  table,  by  Langley,  illustrates  the  probable 
relations  of  the  spinal  roots  to  the  ganglia  of  the  sympathetic 
system  in  man,  according  to  which  the  chief  outflow  of 
sympathetic  fibers  occurs  between  the  first  thoracic  and 
second  lumbar  roots. 


425 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 


Fig.  102. — Schematic  representation  of  the  course  of  the  autonomic  (sympa- 
thetic) fibers  arising  from  the  thoracico-lumbar  and  sacral  regions  of  the  cord. 
The  arrows  indicate  the  normal  direction  of  the  nerve-impulses  or  nerve-conduction. 
Sc.,  superior  cervical  ganglion;  Ic.,  inferior  cervical  ganglion;  T.,  first  thoracic 
ganglion;  Sp.,  splanchnic  nerve;  C.,  semilunar  or  celiac  ganglion;  m,  inferior 
mesenteric  ganglion;  h,  hypogastric  nerves;  N.  E.,  nervus  erigens.  The  numerals 
indicate  the  corresponding  spinal  nerves.  Vide  Fig.  74. 

426 


Ganglia  of  the  Sympathetic  System 


GANGLIA  OF  THE  SYMPATHETIC  SYSTEM. 


SPINAL-ROOT. 

CERVICAL. 

THORACIC. 

LUMBAR. 

SACRAL. 

I 

Sup.  cerv. 

II 

Sup.  cerv. 

III 

Sup.  cerv. 

IV 

Sup.  and  inf. 
cerv  

V 

Sup.  and  inf. 
cerv  

I,  2 

VI 

Sup.  (?)  and 
inf.  cerv.  .  . 

I,  2,  3,  4,  S 

ThoracicVII 

Inf.  cerv  

i,  2,  3,  4,  5,  6,  7,  8,  9 

VIII 

?    S,  6.  7.  8,  Q.  IO.  II,  12 

IX 

?  8,  9,  10,  ii,  12 

I,  2 

X 

II,  12 

I.  2.  \ 

XI 

12 

I    2.  1    d. 

XII 

I,  2.  3,  4,  5 

I 

I 

?    2,  3,  A,  ? 

I,  2.  3 

Lumbar  II 

?   •?,  4,  ^ 

I.  2,  7,  4,  C 

The  ganglia  of  the  sympathetic  nervous  system  are  as 
follows:  Cervical  portion,  3,  Dorsal,  12,  Lumbar,  4,  and 
Sacral,  4  or  5  pairs  of  ganglia. 

The  cervical  sympathetic,  which  supplies  the  majority 
of  the  blood-vessels  of  the  head,  obtains  its  fibers  from  the 
first  to  the  seventh  thoracic  roots,  all  of  which  terminate  in 
the  superior  cervical  ganglion  which  is  located  opposite  the 
second  and  third  cervical  vertebrae. 

The  upper  extremities,  are  supplied  by  vasomotor  nerves 
which  terminate  in  the  first  thoracic  ganglion. 

The  vasomotor  nerves  of  the  lower  extremities  pass 
through  the  nerves  of  the  lumbar  and  sacral  plexuses  into  the 
sympathetic. 

TEST  FOR  THE  SPLANCHNIC  CIRCULATION. — Recapitulat- 
ing certain  facts  concerning  splanchnic  neurasthenia  (pages 
252,  345)  we  note  that  it  is  a  condition  dependent  on  intra- 
abdominal  venous  congestion  superinduced  by  insufficiency 
of  the  splanchnic  vasomotor  mechanism,  and  that  the  neur- 

427 


Spondyloth     e    r    a    p 


y 


asthenic  symptoms  resulting  therefrom  may  be  corrected  by 
by  relief  of  the  congestion,  and  by  maneuvers  which  will 
increase  the  efficiency  of  the  liver  as  an  organ  of  defense. 

Toning  the  splanchnic  vasomotor  mechanism  is  the  most 
potential  of  all  methods  in  the  treatment  of  splanchnic 
neurasthenia. 

It  has  already  been  observed  on  page  346,  that  when  one 
presses  the  abdomen,  or  when  the  sinusoidal  current  is 
applied  to  the  abdomen,  the  blood  is  driven  from  the  intra- 
abdominal  veins  back  into  the  heart.  The  latter  action  is 
chiefly  due  to  the  elicitation  of  the  liver  reflex  (page  331), 
which  results  in  a  decided  reduction  in  the  volume  of  the 
liver.  Insomuch  as  it  has  been  estimated  that  the  latter 
organ  contains  blood  equivalent  to  one-fourth  the  amount 
of  blood  contained  in  the  body,  it  is  not  difficult  to  conceive 
that,  by  contraction  of  the  liver  alone,  considerable  blood 
may  be  expressed  from  the  splanchnic  circulation. 

However,  the  author  finds  that  it  is  now  possible  to  in- 
fluence the  latter  circulation  by  direct  stimulation  of  the 
splanchnic  nerves  which  control  the  blood-vessels  of  the 
abdominal  organs. 

True,  digitalin  or  strophanthin,  alone  or  in  combination, 
quickly  relieve  abdominal  congestion.  They  are  endowed 
with  the  property  of  constricting  the  splanchnic  vessels  alone, 
whereas  digitoxin  constricts  all  the  blood-vessels. 

However,  with  pharmaco-therapy  only  temporary  results 
are  achieved,  and  the  latter  should  be  superseded  whenever 
possible  by  physio-therapy. 

Before  describing  the  physio-therapeutic  method  of  the 
author,  it  is  necessary  to  advert  succinctly  to  the  splanchnic 
circulation. 

The  latter  properly  comprises  the  arterial  and  venous 

428 


Splanchnic        Circulation 

supply  to  the  abdominal  organs  and  is  known  as  the  splanch- 
nic area.  The  largest  vascular  areas  in  the  body  are : 

1.  The  splanchnic  area; 

2.  The  brain; 

3.  The  muscles; 

4.  The  skin. 

The  splanchnic  area  is  large  enough  to  contain  almost 
the  entire  volume  of  blood  of  the  body. 

If  the  portal  vein  is  tied,  practically  the  entire  blood- 
volume  of  the  body  will  accumulate  in  the  intestinal  and 
hepatic  blood-vessels  and,  in  this  way,  an  animal  may  be 
bled  into  its  own  veins. 

There  is  an  incongruity  in  an  animal  like  man  built  on 
the  longitudinal  plan.  The  erect  posture  of  man  causes  the 
blood  to  gravitate  into  the  intra-abdominal  veins. 

The  effect  of  gravity  on  the  circulation  is  important, 
The  chief  effect  of  gravity  is  that  the  veins  become  filled 
with  blood  in  the  dependent  parts.  If  an  animal  is  held  with 
its  legs  hanging  down,  the  amount  of  blood  going  to  the 
heart  is  reduced  and  the  blood-pressure  in  the  arteries  is 
consequently  diminished.  This  hydrostatic  effect  of  gravity, 
however,  is  overcome  in  the  norm  by  constriction  of  the  ves- 
sels of  the  splanchnic  area  and  by  augmented  vigor  of  the 
respiratory  apparatus. 

If  a  "hutch"  rabbit  is  suspended  by  the  ears  with  its  legs 
hanging  down,  it  soon  passes  into  unconsciousness  and  will, 
if  left  in  that  position,  die  in  about  half  an  hour.  What 
occurs?  The  blood  leaving  the  brain  accumulates  in  the 
abdomen  of  the  animal  but  the  deficient  tone  of  its  splanchnic 
vasomotor  mechanism  is  unable  to  overcome  the  evil  effects 
of  gravity. 

If  the  animal,  however,  is  placed  in  a  horizontal  posture 

429 


Spondyloth     e    r    a    p    y 

or,  if  while  still  suspended,  the  abdomen  is  squeezed  or 
bandaged,  consciousness  is  soon  restored. 

A  wild  rabbit,  owing  to  its  efficient  splanchnic  vasomotor 
mechanism,  suffers  no  inconvenience  when  held  in  a  vertical 
position. 

The  SPLANCHNIC  NERVES,  are  the  vasomotor  nerves  of 
the  abdominal  blood-vessels  and  control  the  largest  vascular 
area  in  the  body. 

If  the  splanchnic  nerves  are  stimulated,  the  blood-vessels 
contract,  but  when  the  nerves  are  cut,  the  vessels  dilate. 

In  the  latter  case,  a  large  amount  of  blood  accumulates 
in  the  abdominal  vessels  resulting  in  an  anemia  of  the  other 
parts  of  the  body  which  may  be  so  great  (brain-anemia)  as 
to  cause  death. 

We  shall  presently  learn  that  the  physician  can  by  simple 
methods  either  increase  or  diminish  the  tone  of  the  splanch- 
nic nerves  and,  in  this  respect,  he  can  achieve  results  tanta- 
mount to  the  vivisectional  experimentalist. 

The  splanchnic  nerves  are  composed  of  fibers  issuing 
from  the  spinal  cord  in  the  5th  to  the  i2th  dorsal  nerves 
inclusive.  The  dorsal  nerves  in  question  correspond  to  the 
spines  of  the  2nd  to  the  8th  dorsal  vertebrae,  inclusive. 

If  the  spines  in  question  are  sinusoidalized,  or  better 
still,  struck  in  succession  by  means  of  a  plexor  and  plexi- 
meter,  the  cardio-splanchnic  phenomenon  (page  346)  is  at 
once  brought  into  evidence.  In  other  words,  the  blood  is 
expressed  from  the  abdominal  vessels  to  the  right  heart. 
The  phenomenon  in  question  is  of  short  duration,  hence  one 
must  not  delay  the  percussion. 

If,  in  the  norm,  an  individual  assumes  the  recumbent 
posture  for  several  minutes  and  is  then  requested  to  stand 
erect,  and  the  physician  at  once  proceeds  to  percuss  the 

430 


The     Splanchnic     Nerves 

lower  part  of  the  abdomen,  he  will  elicit  two  areas  of  dull- 
ness as  shown  in  Fig.  103. 

The  latter  areas  are  usually  of  short  duration  and  may 
be  dissipated  at  once  by  a  series  of  deep  breaths  or  by 
striking  the  2d  to  the  8th  dorsal  vertebral  spines. 

What  reasons  have  we  for  assuming  that  the  dull  areas 
in  question  are  caused  by  the  accumulation  of  blood  in  the 
abdominal  blood-vessels  ? 

1.  The   areas   of   dullness   correspond   to   the   largest 
abdominal  vessels. 

2.  They  are  at  once  dissipated  by  deep  breathing  which 
facilitates  the  return  of  blood  from  the  abdominal  vessels  to 
the  heart  and  by  striking  or  sinusoidalizing  the  spines  of  the 
sd  to  the  8th  dorsal  vertebrae.    The  latter  methods  stimu- 
late the  splanchnic  nerves  and  by  thus  constricting  the 
vessels  of  the  abdomen  send  the  blood  to  the  heart.    Thus 
it  is,  that  by  the  execution  of  the  methods  in  question,  the 
cardio-splanchnic  phenomenon  is  brought  into  evidence. 

3.  If  a  large  vacuum  cup  is  applied  to  the  abdomen  at 
a  point  just  above  the  navel,  and  the  cup  is  exhausted,  two 
areas  of  dullness  corresponding  to  Fig.  103,  appear. 

4.  If,  in  a  given  individual,  the  dull  areas  corresponding 
to  Fig.  103,  are  elicited  by  a  change  from  the  recumbent  to  the 
vertical  position,  such  areas  can  no  longer  be  demonstrated 
by  change  of  position  if  the  vertebral  spines  corresponding 
to  the  origin  of  the  splanchnic  nerves  are  previously  sinu- 
soidalized  or  concussed.     By  the  latter  method,  we  have 
at  least  temporarily,  augmented  the  tone  of  the  splanchnic 
vasomotor  mechanism,  thus   inhibiting  the   gravitation   of 
blood  to  the  abdominal  vessels  in  sufficient  amount  to  elicit 
dullness. 

5.  The  dull  areas  may  be  evoked  (although  absent)  in 
the  erect  posture,  by  sinusoidalization  or  concussion  of  the 

431 


Spondylotherapy 

four  lower  dorsal  spines  (gth,  loth,  nth  and  i2th  dorsal 
vertebrae). 

The  author  has  determined  empirically  that  the  spines 
in  question  correspond  to  segments  in  the  spinal  cord  which, 
when  stimulated,  will  diminish  the  tone  of  the  splanchnic 
nerves,  thus  permiting  a  large  quantity  of  blood  to  gravitate 
into  the  patulous  abdominal  vessels. 

6.  In  splanchnic  neurasthenics,  the  patches  of  dullness 
are  not  isolated  as  in  the  norm  but  the  dullness  is  diffused 
and  occupies  the  entire  lower  abdomen  (Fig.  104).  With  the 
betterment  of  the  splanchnic  neurasthenic  there  is  a  corres- 
ponding diminution  of  the  dullness  on  percussion.  The 
dullness  in  such  patients  is  always  more  diffused  and  pro- 
nounced when  the  symptoms  of  the  patient  are  accentuated, 
and  it  is  even  possible  to  elicit  many  of  their  sensations 
(vertigo,  sinking  sensations,  lack  of  energy,  etc.)  or  aggra- 
vate them,  by  concussion  or  sinusoidalization  of  the  four 
lower  dorsal  spines  which,  as  we  have  shown,  practically 
paralyze  the  splanchnic  nerves,  thus  causing  an  increased 
quantity  of  blood  to  accumulate  in  the  abdominal  vessels.* 

The  author,  based  on  an  examination  of  hundreds  of 
cases  with  reference  to  the  vigor  of  the  splanchnic  vaso- 
motor  mechanism  submits  the  following  classification: 

1 .  Patients  in  whom  no  dullness  in  the  lower  abdomen 
can  be  elicited  when  a  change  is  made  from  the  recumbent 
to  the  erect  posture;  a  condition  which  demonstrates  an 
ideal  vaso-motor  mechanism. 

2.  Patients  in  whom  a  dullness  of  short  duration  (last- 
ing about  one  minute),  is  elicited  (Fig.  103)  on  change  of 
position;  a  condition  representing  an  average  vaso-motor 
mechanism. 

*The  author  suggests  to  the  investigator  that  the  dullness  of  intra-abdominal  con- 
gestion be  utilized  as  a  gauge  in  determining  the  action  of  drugs  on  the  splanchnic 
circulation. 

432 


The     Splanchnic    Nerves 

3.  Patients  in  whom  the  dullness  is  diffused  (Fig.  104) 
and  persistent  (longer  than  three  minutes),  after  change 
from  the  recumbent  to  the  erect  position;  a  condition  repre- 
senting an  enervated  mechanism. 


Fig.  103. 

Fig.  103. — Patches  of  dullness  in  the 
norm,  when  the  erect  is  substituted  for 
the  recumbent  posture;  percussional 
evidence  of  the  gravitation  of  blood  into 
the  splanchnic  vessels  by  the  attitudinal 
change  in  question. 


Fig.  104. 

Fig.  104. — Diffused  area  of  dullness 
in  insufficiency  of  the  splanchnic  vaso- 
motor  mechanism.  Compare  with  the 
normal  areas  of  dullness  in  Fig.  103. 


4.  Patients  in  whom  the  dullness  is  diffused  and  per- 
sistent in  the  erect  posture  without  having  previously  adopted 
the  recumbent  attitude.  Here,  we  are  confronted  with  the 
most  accentuated  types  of  splanchnic  neurasthenia. 

From  what  has  preceded  it  will  be  evident  that  one  must 
not  base  inferences  on  false  premises.  One  must  assure 
himself  that  dullness  of  the  lower  abdomen  is  really  depend- 
ent on  intra-abdominal  congestion  by  execution  of  the  tests 
already  cited.  Thus,  there  will  be  an  augmentation  of  the 
dullness  if  the  four  lower  dorsal  spines  are  concussed  or, 
conversely,  the  dullness  will  be  dissipated  by  deep  breathing 

433 


Spondyloth     e    r    a    p    y 

(in  non-aggravated  types  of  congestion)  or  by  concussion 
of  the  upper  dorsal  spines  (2d  to  the  8th). 

In  the  TREATMENT  of  splanchnic  neurasthenia,  two 
methods  are  available,  viz.: 

1.  Concussion. 

2.  Sinusoidalization. 

Concussion  is  more  efficient  than  sinusoidalization.  Con- 
cussion is  a  mechanic  stimulus  and,  when  it  is  of  short  dura- 
tion, it  augments  the  excitability  of  the  nerves,  but  when 
prolonged,  the  excitability  is  diminished  or  abolished.  It 
is  evident  then  that,  in  the  application  of  a  seance  of  con- 
cussion, the  treatment  must  be  intemiDted  from  time  to 
time. 

Mechanic  stimuli  are  only  effective  when  they  are  applied 
with  sufficient  rapidity  to  produce  a  change  in  the  form  of 
the  nerve-particles. 

In  the  therapeutic  elicitation  of  the  splanchnic  reflex  of 
vaso-constriction,  the  only  kind  of  vibratory  apparatus  which 
is  effective  is  one  giving  a  PERCUSSION  STROKE.  The  con- 
cussion is  applied  directly  to  the  spinous  processes  in  suc- 
cession. 

The  duration  of  each  daily  seance  should  not  be  less  than 
15  minutes,  but  treatment  must  be  interrupted. 

Sinusoidalization  may  likewise  be  used  for  exciting 
the  splanchnic  reflex  of  vaso-constriction.  The  rapid  sin- 
usoidal current  is  employed  for  this  object. 

A  large  electrode  is  placed  over  the  sacrum,  whereas  a 
small  interrupting  electrode  (which  permits  one  to  close  and 
open  the  circuit)  is  placed  in  succession  over  the  indicated 
spinous  processes. 

The  daily  seances  must  be  at  least  of  15  minutes  duration, 
but  interrupted. 

434 


The     Splanchnic     Nerves 

In  concluding  this  subject,  the  author  wishes  to  direct 
attention  to  the  vertebral  reflexes  in  diminishing  the  volume 
of  the  liver  which,  in  splanchnic  neurasthenia  is  invariably 
enlarged. 

Our  conventional  conception  of  the  liver  is  that  of  an 
organ  which  is  hard  and  unyielding. 

In  reality,  however,  the  organ  in  question  is  like  a  sponge ; 
it  swells  with  augmenting,  and  diminishes  in  volume  with 
decreasing  pressure. 

Concussion  of  specific  vertebral  spinous  processes  con- 
tracts the  liver  for  the  following  reasons : 

1.  Concussion  of  the   yth  cervical  spine  acts  on  the 
general  vaso-motor  apparatus. 

2.  Concussion  of  the  first  three  lumbar  spines  acts  by 
eliciting  the  liver  reflex  (page  331)  of  contraction. 

3.  Concussion  of  the  2d  to  the  8th  dorsal  spines,  in- 
clusive, acts  by  constriction  of  the  splanchnic  blood-vessels. 

In  a  number  of  measurements  of  the  liver  made  in  the 
parasternal  line,  the  author  obtained  the  following  results: 

1 .  Size  of  liver  by  percussion  before  concussion,  12.5  cm. 

2.  Size  of  liver  after  concussion  of  yth  cervical  spine, 
ii  cm. 

3.  Size  of  liver  after  concussion  of  ist  3  lumbar  spines, 
8  cm. 

4.  Size  of  liver  after  concussion  of  2d  to  8th  dorsal 
spines,  6  cm. 

It  is  evident,  according  to  the  foregoing  measurements, 
that,  after  elicitation  of  the  splanchnic  reflex  of  vaso-con- 
striction  (4),  the  greatest  reduction  in  the  volume  of  the 
liver  is  obtained.* 


*The  essential  facts  of  this  subject  have  been  excerpted  from  the  4th  edition  of  the 
author's  work,  Splanchnic  Neurasthenia,  E.  B.  Treat  &  Co.,  New  York. 

435 


Spondyloth 


a    p    y 


6.  PiLO-MoTOR  REFLEXES. — Stimulation  of  the  pilo- 
motor  nerves,  causes  contraction  of  the  erectores  pilorum,  and 
the  reflex  causes  the  appearance  of  "goose-skin"  (cutis 
anserina).  When  the  muscles  (erectores  pilorum)  attached 
to  the  hair-roots  contract,  in  addition  to  the  goose-skin,  one 
experiences  a  chilly  sensation  which  is  probably  due  to  vaso- 
constriction. 

Mackenzie68  observes  that,  if  the  skin  under  the  nipple 
is  rubbed  with  flannel,  goose-skin  appears  over  the  part 


Fig.  105. — Composite  dikgram  of  pilo-motor  reflexes. 

rubbed  and  extends  to  the  clavicle  and  to  the  inner  side  of 
the  upper  arm  and  forearm.  At  the  same  time  the  pupil 
dilates.  This  phenomenon  is  explained  by  noting  that  the 
dilator  pupillae  nerve  leaves  the  spinal  cord  (at  a  point  where 
the  part  has  been  rubbed),  by  the  upper  thoracic  nerves. 

In  Fig.  105, 1  have  projected  a  composite  picture  of  pilo- 
motor  reflexes,  as  shown  by  goose-skin  over  different  verte- 
bral areas,  after  irritation  of  different  peripheral  regions 
with  some  sharp  object.  The  numbers  refer  to  the  vertebral 
region  where  the  goose-skin  is  seen  or  felt  by  the  patient. 
Thus,  the  region  over  the  anterior  surface  of  the  thigh  is 
designated  ist  and  5th  lumbar,  indicating  that  the  goose- 

436 


Paravertebral     Tenderness 

skin  is  observed  over  these  vertebrae.  The  results  are  only 
approximate.  Subdued  light  must  be  used.  Limited  areas 
of  anemia  with  elevation  of  hairs  are  associated  with  the 
goose-skin.  In  other  instances,  a  faint  tremor  of  the  muscles 
may  be  noted.  The  pilo-motor  reflexes  are  rapidly  exhausted. 

7.  PARAVERTEBRAL   TENDERNESS. — This   subject  has 
already  been  discussed  on  page  71,  et  sequentia,  and  I  have 
not  modified  my  views  respecting  the  reason  for  the  tender- 
ness.   Certainly  it  is  not  a  question  of  congestion,  insomuch 
as  cupping  to  one  side  of  the  tender  areas  only  accentuates 
the  vertebral  and  peripheral  areas  of  tenderness.    We  asso- 
ciate tenderness  with  congestion  despite  the  fact  that  pain 
is  often  the  piteous  appeal  of  a  hungry  nerve  for  blood.    In 
several  instances,   when  freezing,  'which  is  the  sovereign 
remedy  for  dissipating  tenderness,  was  ineffective,  notably 
in  intercostal  pains,  suspension  of  the  patient  (Fig.  1 16),  caused 
the  disappearance  of  the  vertebral  and  peripheral  points  of 
tenderness.     Here  one  assumed,  and  the  results  demon- 
strated the  verity  of  the  assumption,  that  the  pains  were 
caused  by  a  faulty  posture  (Vide  foot-note,  page  186). 

8.  ELEVATION  OF  TEMPERATURE. — Rise  of  temperature 
consecutive  to  concussion  has  already  been  noted  on  page 
1 80.     Recently,  the  author  has  observed  the  curious  fact 
that  pressure  exerted  and  maintained  for  about  two  minutes 
with  an  instrument  (Fig.  112)  at  the  vertebral  exits  of  any  of 
the  spinal  nerves,  will  also  elevate  the  temperature  from  .6  to 
1.6°  F.  The  mechanic  irritation  thus  evoked,  is  equivalent 
to  a  pathologic  irritation  caused  by  visceral  disease  and 
manifested  by  areas  of  vertebral  tenderness. 

The  fact  just  cited  may  explain  the  elevation  of  temperature  in 
some  conditions.  The  even  temperature  of  the  body  is  maintained  by 
a  thermotactic  condition  which  adjusts  the  rate  of  heat-production 
(thermogenic  factor)  and  heat-radiation  (thermolytic  factor). 

437 


Spondyloth     e    r    a    p    y 


Fig.  106. — Representing  the  mechanism  of  visceral  pain,  cutaneous  and 
muscular  hyperalgesia  (viscero-sensory  reflex),  the  viscero-motor  reflex  and  the 
organic  reflex.  A  stimulus  from  the  organ,  V,  by  the  sympathetic  nerve  (Sy.  N.), 
to  its  center  in  the  spinal  cord  extends  to  the  adjacent  cells  of  nerves,  and  excites 
them  to  activity,  when  the  function  peculiar  to  each  nerve  is  exhibited.  Thus  the 
stimulus  affecting  the  cells  of  a  pain- nerve  (SN),  eventuates  in  the  perception  of 
pain  which  is  referred  by  the  brain  to  the  peripheral  distribution  of  the  nerve  in  the 
external  body-wall  (Sk.  M);  affecting  the  cell  of  a  motor  nerve  (MX),  causes  a  con- 
traction of  the  muscle  (M),  supplied  by  the  motor  nerve;  affecting  the  cells  innervat- 
ing other  viscera  (as  V),  stimulates  them  to  their  peculiar  function  (contraction  of 
a  hollow  muscular  viscus,  increased  secretion  of  a  secretory  organ) .  If  the  stimulus 
is  of  sufficient  strength,  it  may  leave  an  irritable  focus  in  the  spinal  cord  (shaded 
area),  as  shown  by  a  persistent  hyperalgesia  of  skin  and  muscle  (Sk.  M),  and  by  a 
persistent  contraction  of  the  muscle  (M). 

438 


Irritable      S  p  i  n  al     Segments 

The  relation  of  the  latter  factors  to  thermo taxis  may  be  repre- 
sented as  follows: 

Thermogenesis. 

Temperature^ 

Thermolysis. 

The  impulses  of  temperature  and  pain  which  are  intimately 
associated,  enter  the  spinal  cord  at  the  same  point  and  pass  into  the 
gray  matter. 

MECHANISM  OF  PERIPHERAL  REFLEXES  IN  VISCERAL 
DISEASE. — Fig.  22  (page  58),  illustrates  cutaneous  tender- 
ness and  radiation  of  pain  in  visceral  disease  and  Fig.  106, 
from  Mackenzie  shows  the  viscero-motor  and  sensory 
reflexes. 

IRRITABLE  SPINAL  SEGMENTS. — Irritable  foci  in  the  cord 
may  survive  the  apparent  cure  of  a  visceral  disease.  This 
is  shown  by  the  persistent  areas  of  vertebral  tenderness,  the 
accentuation  of  physiologic  reflexes,  persistent  dermatomes, 
reflex  muscular  contractions  corresponding  to  the  irritable 
spinal  segment,  and  subjective  sensations  corresponding  to 
the  hypersensitive  spinal  segments.  It  is  not  unusual  for 
patients  to  complain  of  pains  or  sensations  in  definite 
regions  of  the  body  (previously  implicated  in  visceral  disease) 
under  emotional  influences. 

PSEUDO- VISCERAL  DISEASES. — It  is  impossible  to  exaggerate  the 
importance  of  this  subject  which  has  already  been  discussed  in  Chapter 
VI.  Neuralgia  of  the  spinal  nerves  is  the  greatest  simulator  of  visceral 
diseases. 

A  spinal  segment  is  a  unit  possessed  of  motor,  sensory,  vaso-motor, 
trophic  and  reflex  functions,  with  regard  to  the  peripheral  distribution 
of  the  roots  of  the  nerves  which  emerge  from  and  enter  it. 

The  following  case  of  pseudo phthisis  is  cited  to  illustrate  the  im- 
portance of  this  subject:  A  young  man  was  sent  to  California  by  his 
physicians  in  consequence  of  a  painful  and  incessant  cough.  Paroxys- 
mal pains  located  in  the  right  upper  chest  were  severe.  The  patient 
had  lost  about  20  pounds  in  weight.  The  auscultatory  evidence  on 

439 


Spondylotherapy 

examination  of  the  upper  lobe  of  the  right  lung  approximating  the 
painful  chest-region,  suggested  an  apical  catarrh. 

The  clinical  picture  was  that  of  pulmonary  tuberculosis  minus  the 
presence  of  tubercle  bacilli  in  the  sputa. 

The  diagnosis  of  an  intercostal  neuralgia  having  been  established, 
three  successive  freezings  of  the  implicated  nerves  at  their  vertebral 
exits  resulted  in  an  immediate  disappearance  of  all  the  symptoms  and 
the  patient  was  rapidly  restored  to  health. 

Here  was  a  man,  stigmatized  as  a  poitrinaire,  by  at  least  seven 
capable  diagnosticians  to  whom  an  atypic  neuralgia  of  a  spinal  nerve 
was  a  terra  incognita.  Fig.  107,  illustrates  schematically,  the  visceral 
phenomena  which  may  ensue  incident  to  the  creation  of  an  irritable 
spinal  segment  by  a  neuralgia  of  a  spinal  nerve. 


Fig.  107. — Diagram  ot  a  spinal  nerve  (Ross).  C,  spinal  cord;  pr,  ar,  posterior 
and  anterior  roots;  SPD,  IPD,  superior  and  inferior  primary  divisions;  d  v,  dorsal 
and  ventral  branches;  sr,  sympathetic  root. 

A  spinal  nerve  with  a  lesion  at,  or  approximating  its  vertebral  exit,  conduces  to 
augmented  irritability  of  a  definite  segment  of  the  cord  with  a  perturbation  of  func- 
tion of  that  particular  segment  as  is  shown  in  Fig.  106. 

REFLEXES  OF  THE  CRANIAL  NERVES.* — Excessive,  or 
anomalous  stimulation  of  the  cranial  nerves  may  react  on  the 
spinal  centers,  thus  provoking  remote  reflexes  which  are 

*To  grasp  this  subject  more  fully  one  should  first  read  Chapter  XIII. 

440 


Reflexes   of  the    Cranial  Nerves 

commonly  misinterpreted.  It  is  now  possible  to  demon- 
strate objectively  this  overflow  of  cranial-nerve  irritation, 
and  thus  eliminate  many  inchoate  data  founded  on  sub- 
jective symptomatology. 

THE  EYE. — Hansell  correctly  observes:  "We  have  not 
yet  advanced  to  that  stage  when  we  study  diseases  of  the 
body  in  relation  to  ocular  defects,  and  fail  to  consider 
diseases  of  the  eye  in  relation  to  general  diseases,"  and 
Helmholtz  contended  that  nature  seems  to  have  packed  the 
eye  with  mistakes,  as  if  with  the  avowed  purpose  of  destroy- 
ing any  possible  foundation  for  the  theory  that  organs  are 
adapted  to  their  environment. 

An  ocular  defect  is  one  of  the  most  common  peripheral 
irritants  in  the  creation  of  reflexes,  and  well-fitting  glasses, 
have  frequently  achieved  the  marvelous  task  of  translating  a 
pessimist  into  an  optimist,  so  essential  is  correct  vision  for 
our  condition  of  well-being. 

The  following  nerves  enter  into  the  innervation  of  the 
eye  and  its  appendages:  i.  Optic  nerve;  2.  Motor  oculi; 
3.  Trochlear  (pathetic);  4.  Trigeminus  (trifacial);  5. 
Abducens;  6.  Facial;  7.  Branches  from  the  carotid  and 
cavernous  plexuses  of  the  sympathetic  system.  The  nerves 
just  cited  anastomose  with  the  vagus  (pneumo-gastric)  and  the 
upper  cervical  nerves. 

Fig.  108  (from  O'Malley79),  represents  a  diagram  of  the 
ocular  nervous  system. 

The  motor  oculi  or  third  cranial  nerve  has  three  sets  of 
fibers,  i .  One  set  supplies  all  the  external  ocular  muscles 
(excepting  the  external  rectus  and  superior  oblique)  and  the 
levator  of  the  upper  lid.  2.  A  set  to  the  pupillary  sphincters. 
3.  A  set  to  the  ciliary  muscle  (muscle  of  accommodation). 

It  is  impossible  even  in  the  norm  to  conceive  the  eye  as 
an  organ  functionating  independently  of  the  other  organs. 

441 


S  p    o     n     d    y    I    o     t    h     e    r    a    p    y 

Reflex  disturbances  are  frequently  initiated  by  refrac- 
tive errors. 

The  refractive  apparatus  is  composed  of  the  cornea,  iris, 
lens  (adjusted  by  the  ciliary  muscle),  and  the  retina.  When 
objects  are  viewed  at  a  distance  of  fifteen  feet  (or  more), 

y    • 


Fig.  108. — The  ocular  nervous  system. 

there  is  a  relaxation  of  the  refractive  apparatus  and  it  is 
passive  (except  the  retina)  in  visualization.  In  normal 
accommodation,  which  is  associated  with  neither  fatigue 
nor  irritation,  objects  near  the  eye  are  focused  clearly  upon 
the  retina  by  involuntary  action  of  the  ciliary  muscle  which 
curves  the  anterior  surface  of  the  lens. 

442 


Reflexes   of  the    Cranial  Nerves 

In  errors  of  refraction,  the  brunt  of  the  burden  is  borne 
by  the  ciliary  muscle  and  nerves,  thus  conducing  to  their 
exhaustion  and  irritation. 

Among  the  reflex  symptoms  of  refractive  disturbances 
are  headaches  and  functional  derangements  of  the  heart  and 
stomach.  Zimmerman,  in  a  study  of  2,000  eye-cases,  cal- 
culated that  over  71  per  cent  suffered  from  headache  and 
de  Schweinitz,  contends  that,  60  per  cent  of  all  ocular 
headaches  are  caused  by  astigmatism. 

I  proceeded  to  study  reflex  symptoms  from  ocular  anom- 
alies by  straining  the  accommodation  of  normal  subjects  and 
by  wearing  glasses  which  caused  asthenopia  (eye-strain  due 
to  fatigue  of  the  ciliary  or  extraocular  muscles).  After  this 
manner,  one  could  note  the  development  of  objective  symp- 
toms. 

Even  in  the  norm,  if  one  eye  of  the  patient  is  covered,  and 
the  other  eye  is  forced  to  view  an  object  under  strain  for  a 
number  of  seconds,  the  primary  manifestation  is  tremor  or 
spasm  of  the  cervical  muscles  on  one  or  the  other  side  (Vide, 
page  124).  Later,  one  or  several  points  of  vertebral  tender- 
ness develop  and  areas  of  sensitiveness  may  be  elicited  in 
the  course  of  the  cervico-occipital  nerves  (midway  between 
the  mastoid  process  and  the  spine,  the  sternomastoid  and 
the  trapezius,  and  above  the  parietal  eminence). 

While  the  eye  is  still  under  strain,  the  tonus  of  the  vagus 
is  augmented;  the  pulse  is  partially  or  completely  inhibited 
(best  seen  in  sphygmograms),  there  is  a  descent  of  the  lower 
lung-border,  recession  of  the  heart  (heart  reflex)  and  the 
stomach  can  be  percussed.  If  the  eye-strain  is  continued, 
the  stomach  alters  its  position  as  in  the  act  of  vomiting.  In 
other  words,  the  chief  reflex  visceral  phenomena  are  mediated 
by  the  vagus.  Mere  pressure  on  the  eye-ball  suffices  to  pro- 

443 


Spondyloth     e    r    a    p    y 

voke  the  vagal  reflexes  but  not  the  reflex  sensory  disturbances 
of  the  cervico-occipital  nerves. 

In  diagnosis,  each  eye  may  be  tested  separately.  The 
signs  observed  in  the  norm  when  accommodation  is  strained 
are  accentuated  and  persistent  in  asthenopia. 

By  this  method  of  testing,  the  symptoms  from  which  the 
patient  suffers  may  be  reproduced  and,  by  inhibiting  the 
ocular  reflexes  (page  443),  the  diagnosis  may  be  clinched. 

Reflex  disturbances  from  the  ear  and  nose  are  described 
in  the  following  chapter. 


T  o    n    u    s      o  f     t   h    e      Vagus 


CHAPTER  XIII. 

TONTJS  OF  THE  VAGUS  AND  PHARMACOLOGY  OF  THE 
REFLEXES.* 

TONUS  OF  THE  VAGUS — ANATOMY  OF  THE  VAGUS — PHYSIOLOGY  AND 
CLINICAL  PATHOLOGY  OF  THE  VAGUS — DIAGNOSIS  OF  VAGUS- 
TONUS — VAGUS-TONE  AND  THE  SENSE  ORGANS — PSYCHOVAGUS- 
TONE — METHODS  FOR  INCREASING  AND  DECREASING  VAGUS- 
TONE — THERAPEUTIC  RESULTS — DISEASES  CAUSED  BY  VAGUS — 
HYPERTONIA  AND  VAGUS — HYPOTONIA — PHYLOGENETIC  DISEASES 
— VAGAL  HYPERESTHESIA — CLINICAL  PHARMACOLOGY. 

TN  this  chapter  the  author  will  endeavor  to  show,  how  by 
mere  pressure  of  certain  vertebral  areas,  one  may  tem- 
porarily or  permanently  inhibit  the  phenomena  of  a  number 
of  diseases  in  consequence  of  the  elicitation  of  definite 
vertebral  reflexes. 

The  citation  of  simple  maneuvers  to  attain  puissant 
results  does  not  impugn  scientific  medicine,  on  the  contrary, 
it  demonstrates  the  paths  of  least  resistance  in  combating 
reflex  phenomena. 

J.  Madison  Taylor88,  in  commenting  on  the  hand  as  a 
therapeutic  agent,  shows  that,  "often  by  clumsy,  empirical 
methods  great  things  are,  and  greater  things  can  be,  thereby 
done."  He  proceeds  to  say,  "The  body  is  like  a  piano  or 
harp,  to  be  played  upon  at  will."  He  relates  how  by 

*This  is  regarded  by  the  author  as  one  of  the  most  important  chapters  in  the  book, 
but  demands  careful  study.  It  shows  that  there  are  many  diseases  regarded  as 
distinct  affections  which  are  merely. symptomatic  of  a  fundamental  condition, 
viz. :  hypotonicity  or  hypertonicity  of  the  vagus.  Thus  it  is  that  several  diseases 
grow  from  a  common  pathogenic  trunk. 


Spondyloth     e    r    a    p    y 

manual  treatment  his  daughter  was  promptly  cured  of  a 
lameness  which  had  resisted  the  efforts  of  the  best  surgeons. 

Much  in  physiotherapy  has  justly  been  discredited, 
owing  to  exaggerated  statements  emanating  from  incompe- 
tent sources.  Cures  mean  nothing  to  the  scientist.  The 
author,  in  the  application  of  his  methods,  has  never  been 
influenced  by  empiricism  alone,  and  the  elicitation  of  his 
reflexes  to  combat  disease  may  easily  be  demonstrated  by 
anybody  reasonably  skilled  in  physical  diagnosis. 

The  subject  of  tonus  of  the  vagus  has  engaged  the  atten- 
tion of  the  author  for  years  and  it  is  only  recently  that  any- 
thing approaching  the  confirmation  of  his  investigations  has 
appeared. 

In  a  monograph*,  which  is  largely  hypothetic,  emanating 
from  the  von  Noorden  clinic,  an  endeavor  has  been  made  to 
demonstrate  the  relation  of  the  tone  of  the  vagus  to  other 
diseases.  Insomuch  as  there  is  no  evidence  in  this  mono- 
graph to  recognize  the  tone  of  the  vagus  by  its  effects  on 
the  visceral  reflexes,  the  discussion  is  necessarily  theoretic. 

Before  studying  this  subject,  it  is  necessary  to  recapitulate 
certain  facts  concerning  the  vagus. 

ANATOMY  OF  THE  VAGUS. — The  tenth  or  pneumo- 
gastric  nerve  (nervus  vagus),  is  the  longest  and  most 
extensively  distributed  cranial  nerve  and  contains  motor 
and  sensory  fibers.  The  branches  of  the  nerve  are 
shown  in  Fig.  109. 

The  vagus  communicates  with  the  gth,  nth  and  i2th 
nerves,  with  the  sympathetic,  and  with  the  loop  between 
the  ist  and  2nd  cervical  nerves.  The  following  are  the 
terminal  branches:  Meningeal,  auricular,  pharyngeal, 
superior  and  inferior  laryngeal,  cardiac,  pericardial, 
bronchial,  esophageal  and  abdominal  branches. 

*DiE  VAGOTONIE;  Eine  Klinische  Studie,  von  Dr.  H.  Eppinger  und  Dr.  L.  Hess. 
Herausgegeben  von  Prof.  Dr.  Carl  von  Noorden.    Berlin,  1910. 

446 


A 


n  a 


t  o  m  y      of     the       Vagus 


GLASSO-PHAR  YNGEAL  HER  VE 

Internal  carotid  artery 

SYMPATHETIC  SUPERIOR  CERVICAL  GANGLION 


External  carotid  artery 


RIGHT  VAGUS  "" 


RECURRENT  PER  VE 


THORACIC  CARDIAC  BRANCH  ' 
(RIGHT  VAGUS) 


A  URICVLAR  BRANCH 
MENINOEAL  BRANCH 
GANGLION  OF  ROOT 


SPIRAL  ACCESSORY 
NERVE 

HYPOGLOSSAL  SERVE 
LOOP  BETWEEN  FIRST 
TWO  C£Z  VIC  A  L  NER  VES 
GANGLION  OF  TRUNK 


SUPERIOR  LABYSGEAL  NERVE 
LEFT  VAGUS 

SUPERIOR  CERVICAL  CARDIAC  BRANCH 


INFERIOR  CERVICAL  CARDIAC  BRANCIf 


CARDIAC  BRANCH  FROM  RECURRENT 
NER  VE 


ANTERIOR  PULMONARY  PLEXUS 
POSTERIOR  PULMONARY  PLEXUS 


SPLENIC  PLEXV* 


Fig.  109. — Diagram  of  the  branches  of  the  vagus  nerves  (Morris). 


447 


Spondylotherapy 

PHYSIOLOGY  AND  CLINICAL  PATHOLOGY  OF  THE  VAGUS. 
The  nerve  is  motor,  for  the  soft  palate,  pharynx,  larynx, 
bronchial  muscle,  heart  and  abdominal  organs.     The  nerve 
is  sensory  for  the  pharynx,  larynx,  trachea,  esophagus  and 
probably  the  heart. 

When  the  nerve  is  diminished  in  tonus  (which  will  be 
described  later),  it  produces  symptoms  varying  in  the  motor 
sphere  from  hypotonia  (page  52),  to  paralysis  and,  in  the 
sensory  sphere,  from  hyperesthesia  (diminished  sensibility), 
to  anesthesia. 

Increased  tonus  of  the  vagus  in  the  motor  sphere  is  asso- 
ciated with  spasms  and  in  the  sensory  sphere  with  hyper- 
esthesia. 

The  following  anomalies  are  associated  with  individual 
branches  of  the  vagus: 

1.  PHARYNGEAL    BRANCHES. — The    muscles,   and 
mucosa  of  the  pharynx  are  implicated  and  deglutition  is 
impaired.     Spasm  of  the  pharynx  is  manifested  by  the 
"globus  hystericus,"  in  hysterical  subjects  and  dysphagia, 
in  nervous  individuals. 

2.  LARYNGEAL  BRANCHES. — Paralysis  and  spasm  of 
the  laryngeal  muscles.     Spasm  is  not  uncommon  in 
children    (laryngismus   stridulus).     Hyperesthesia   and 
anesthesia  of  the  laryngeal  mucosa. 

3.  CARDIAC  BRANCHES. — The  motor  fibers  inhibit 
and  control  the  action  of  the  heart.     In  hypertonicity, 
the  heart's  action  is  retarded,  whereas,  in  hypotonicity, 
owing  to  the  uninfluenced  accelerator  action,  all  grades 
of  heart-hurry  (tachycardia)  may  be  present.    The  sen- 
sory symptoms  in  lesions  of  these  branches  include  ir- 
regularities, palpitation,  and  other  subjective  symptoms 
of  cardiac  neuroses.     In  lesions  of  the  vagus,  fatty  de- 
generation of  the  myocardium  has  been  observed,  hence 
the  nerve  has  a  trophic  function. 

The  inhibitory  action  of  the  vagus  on  the  heart  is 
manifested  in  controlling  the  rhythmicity  (chronotropic 

448 


Physiology     of    the     Vagus 

action),  irritability  (bathmotropic),  conductivity  (dromo- 
tropic),  contractility  (inotropic),  and  tonicity. 

Blood-pressure  is  indirectly  under  vagus-control. 

4.  PULMONARY  BRANCHES. — The  motor  fibers  in  a 
hypertonic    state    produce    spasmodic    bronchostenosis 
(page  311),  and  asthma,  whereas,  in  a  hypotonic  con- 
dition, they  conduce  to  dilatation  of  the  lungs  and  em- 
physema.    One  knows  that  the  vagus  contains  fibers 
which  can  constrict  or  dilate  the  bronchi  (page  308). 
In  hypertonia  of  the  nerve,  the  sensitized  mucosa  of  the 
air-passages  accentuates  the  cough-reflex. 

5.  ESOPHAGEAL  BRANCHES. — Spasm  of  the  esoph- 
agus (esophagismus),  cardiospasm  and  paralysis.     Dys- 
phagia  is  the  essential  symptom  in  these  conditions. 

6.  GASTRIC  BRANCHES. — Insomuch  as  the  vagus  is 
the  motor  nerve  of  the  stomach,  it  is  identified  with  the 
motor  neuroses  of  the  organ.    The  vagus  also  contains 
secretory  nerves  for  the  gastric  mucosa,  and  is  therefore 
associated  with  the  secretory  and  most  probably  with  the 
sensory  neuroses  of  the  stomach. 

Among  other  functions  attributed  to  the  vagus  are: 
Vasoconstrictor  fibers  for  the  heart,  stomach,  intestine, 
kidneys,  spleen,  and  possibly  the  lungs;  vasodilator 
fibers  for  the  coronary  vessels  and  the  lungs,  inhibitory 
fibers  for  the  cardiac  sphincter  of  the  stomach,  longi- 
tudinal muscles  of  the  small  intestine  and  bronchial 
muscles,  and  secretory  nerves  of  the  pancreas. 

Another  important  function  of  this  nerve  is  to  main- 
tain the  tonus  of  the  thoracic  and  abdominal  viscera. 

There  are  many  problems  in  the  physiology  of  this 
nerve  which  have  not  been  solved  by  the  physiologist, 
hence  the  aid  of  the  clinician  must  not  be  ignored,  inso- 
much as  the  nature  of  many  diseases  is  revealed  by  the 
remedies  employed. 

NERVOUS  SYSTEM. — This  is  divided  into  cerebro-spinal 
and  sympathetic. 

The  cerebro-spinal  system  consists  of  the  brain,  spinal 

449 


Spondyloth     e    r    a    p    y 

cord,  cranial  and  spinal  nerves.  It  supplies  the  special 
senses  and  the  voluntary  muscles. 

The  sympathetic  nervous  system  (Fig.  101),  presides  over 
the  visceral  movements,  controls  the  phenomena  of  secretion 
and  influences  the  caliber  of  the  blood-vessels. 

Anatomically,  these  two  nervous  systems  are  with  diffi- 
culty differentiated,  but  this  difficulty  is  surmounted  by  the 
use  of  nicotin.  The  function  of  the  sympathetic  fibers  is 
inhibited  by  painting  them  with  nicotin,  whereas  the  same 
agent  is  without  effect  on  fibers  of  the  cerebro-spinal  system. 

The  sympathetic  system  is  composed  of  fibers  which 
according  to  their  origin  may  be  divided  into  cranial,  bulbar 
and  sacral  (Fig.  101). 

1.  CRANIAL  DIVISION. — This  is  composed  essentially 
of  fibers  which  pass  to  the  eye  through  the  oculo-motor 
nerve. 

2.  BULBAR  DIVISION. — The  fibers  of  this  division 
pass  through  the  facial  and  glosso-pharyngeal  nerves 
and  innervate  the  glands  and  blood-vessels  of  the  head. 
The  chief  nerve  of  this  division  is  the  vagus,  which  is  the 
chief  nerve  of  the  viscera. 

3.  SACRAL  DIVISION. — This  innervates  the  struc- 
tures shown  in  Fig.  101. 

FURTHER  DIFFERENTIATION  OF  THE  SYMPATHETIC. — All 
the  nerve-fibers  of  this  system  which  run  into  the  gangliated 
cords  of  the  sympathetic  (Fig.  102),  are  known  as  sympathetic 
fibers,  whereas  the  others  are  called  autonomic  (page  411), 
which  represent  essentially  the  extended  vagus. 

These  two  sets  of  fibers  are  physiologically  in  antagonism; 
the  irritation  of  one  set  inhibiting  the  functions  of  the  other 
set.  Each  set  shows  a  definite  pharmacologic  reaction 
equivalent  to  their  electric  stimulation. 

ADRENALIN  acts  exclusively  on  the  sympathetic,  whereas 
the  autonomic  fibers  are  stimulated  by  PILOCARPIN. 

450 


T  o  ,n   u    s      of     the      Vagus 

The  behavior  of  atropin  is  peculiar.  It  may  inhibit 
the  action  of  other  drugs  on  the  autonomic  fibers  and 
while  its  action  is  most  powerful  on  the  cranial  division,  it  is 
practically  without  effect  on  the  sacral  division. 

THE  CHROMAFFIN  SYSTEM. — This  refers  to  an  organ  or 
group  of  organs  made  up  of  certain  cells  which  show  a 
specific  staining  reaction  with  the  salts  of  chromium.  These 
cells  have  the  same  embryonic  origin  as  the  sympathetic 
nerves  and  are  found  with  the  latter  in  groups  from  the 
base  of  the  skull  to  the  bottom  of  the  pelvis. 

The  medullary  portion  of  the  adrenal  glands  contains  the 
largest  group  of  these  cells  from  which  epinephrin  is  derived. 

There  is  an  intimate  relation  existing  between  the 
thyroid  and  pancreas  and  the  chromaffin  system. 

TONUS  OF  THE  VAGUS. — What  has  been  said  on  page  409, 
respecting  the  tone  of  muscles  applies  with  equal  cogency 
to  the  viscera.  In  health,  the  viscera  are  in  a  state  of 
tonicity,  i.  e.,  their  musculature  is  in  a  more  or  less  permanent 
although  variable  condition  of  contraction.  Physiologists 
give  us  little  information  concerning  the  factors  controlling 
visceral  tonicity,  although  they  admit  that  the  function  is 
most  important  in  regulating  the  cavities  of  the  heart  and 
other  organs. 

The  sympathetic  fibers  are  stimulated  experimentally 
by  adrenalin  (sympathicotropic  action),  and  the  tonus  of 
these  fibers  in  the  organism  is  maintained  by  the  constant 
secretion  of  adrenalin  and  other  products  (epinephrin, 
suprarenalin),  from  the  adrenal  bodies.  A  similar  internal 
secretion  has  not  yet  been  demonstrated  for  maintaining  the 
tonus  of  the  autonomic  fibers,  although  we  know  that  such 
physiologic  action  can  be  exhibited  by  pilocarpin  (vagotropic 
action). 

It  has  been  shown  that  the  pancreas  has  an  inhibitory 

451 


S  p     o     n     d    y    I    o     t    h     e     r    a    p    y 

influence  on  the  secretion  of  adrenalin  and  that  after  extir- 
pation of  the  pancreas,  adrenalin  is  increased.  When  the 
adrenalin  secretion  is  augmented,  the  reflexes  of  the  sym- 
pathetic fibers  are  increased,  and  conversely,  diminished 
when  the  secretion  is  reduced.  The  pharmacologic 
excitation  cited,  is  analogous  to  what  occurs  when  the 
sympathetic  fibers  supplying  the  iris  are  cut,  viz.,  pupillary 
contraction  and  dilatation  of  the  pupil,  when  the  autonomic 
fibers  are  divided. 

In  the  norm,  when  an  adrenalin  solution  is  dropped  into 
the  eye,  no  dilatation  of  the  pupil  ensues,  but  in  diabetes, 
with  pancreatic  involvement,  such  instillation  causes  mydri- 
asis.  In  diseases  of  the  pancreas,  the  inhibitory  influence 
of  the  pancreas  on  adrenalin  secretion  is  checked.  When 
the  sympathetic  and  autonomic  fibers  are  equally  stimulated, 
we  have  what  is  known  as  tonic  innervation. 

In  my  experimental  and  clinical  work,  I  have  concerned 
myself  chiefly  with  the  tonus  of  the  vagus  and  clinical 
pictures  have  been  evolved  which  are  identified  either  with 
a  diminution  of  vagus- tone  (vagus-hypotonia),  or  an  aug- 
mentation of  tone  (vagus-hypertonia).  Variations  in  vagus- 
tone  may  involve  the  entire  nerve,  or  it  may  be  confined  to 
one  or  more  of  its  individual  branches  (Local  vagus-hypotonia 
or  hypertonia). 

Humans,  like  animals,  show  variations  in  vagus-tone. 
Thus  in  some  animals,  section  of  the  vagus  (vagotomy), 
will  produce  tachycardia,  whereas  in  other  animals  no  such 
action  is  observed.  The  vagus  is  more  active  in  middle  life 
than  in  old  age,  and  least  active  in  infancy. 

In  some  humans,  infinitesimal  doses  of  atropin  (which 
inhibit  vagus-impulses),  will  produce  tachycardia,  mydriasis, 
glycosuria,  etc.,  whereas  in  others  large  doses  of  the  same 
drug  produce  scarcely  any  effects. 

452 


Diagnosis    of    Vagus-tonus 

DIAGNOSIS  OF  VAGUS-TONUS. — i.  Pharmacologic  meth- 
ods. 2.  Paravertebral  pressure.  3.  Therapeutic  results. 

i.  PHARMACOLOGIC  METHODS. — Insomuch  as  adrenalin 
acts  exclusively  on  the  sympathetic,  and  pilocarpin  on  the 
autonomic  fibers,  adrenalin  will  ameliorate  symptoms 
caused  by  augmented  vagus-tonus,  whereas  pilocarpin  will 
increase  them. 

If  one  concusses  the  first  three  lumbar  spines  to  produce 
the  stomach  re/lex  of  contraction  (page  316),  one  finds  that, 
after  an  hypodermatic  injection  of  8  minims  of  a  solution  of 
adrenalin  chlorid,  i  :iooo,  the  stomach  instead  of  contracting 
as  in  the  norm,  dilates  (stomach  reflex  of  dilatation).  Thus, 
before  concussion  of  the  spines  in  question,  the  stomach 
retracted  2j  cm.,  whereas  after  the  injection,  it  dilated  2  cm. 

After  an  injection  of  pilocarpin,  the  stomach  reflexes  are 
accentuated. 

.Thus, 

Stomach  reflex  of  contraction  before  injection,  3    cm. 

"  "    "          "  after         "          5    cm. 

"    "  dilation       before       "          2    cm. 

"    "          "  after         "          3.8  cm. 

Atropin  paralyzes  the  motor  endings  of  the  vagus.  An 
injection  of  o.ooi  gm.  (gr.  1-60),  of  the  latter  drug  will 
manifest  its  action  within  thirty  minutes  and  disappears  in 
from  one  to  three  hours.  During  the  full  physiologic  action 
of  the  drug,  the  stomach  reflexes  are  abolished. 

Atropin  may  thus  be  utilized  in  excluding  any  aug- 
mented irritability  (hyperkinesis)  of  the  vagus-endings  in  the 
stomach.  Thus  the  motor  neuroses  of  the  organ  (super- 
motility,  peristaltic  unrest,  gastric  crises,  spasm  of  the 
cardia,  and  pylorus,  etc.),  must  yield  to  an  adequate  dose  of 
atropin.  An  injection  of  pilocarpin  will,  on  the  contrary, 
accentuate  the  motor  neuroses. 

453 


Spondyloth     e    r    a    p    y 

A  gastric  ulcer  will  simulate  many  gastric  diseases. 

In  suspected  ulcer,  a  drachm  of  salt  in  a  glass  of 
water,  ingested  on  an  empty  stomach  will  excite  an 
attack  of  pain. 

Hydrogen  peroxid,  used  for  the  same  object,  causes 
a  burning  sensation. 

Orthoform  (8  grains),  in  one  ounce  of  hot  water  will 
only  arrest  the  pains  of  an  abraded  surface  (ulcer). 

If  the  gastric  pain  is  caused  by  hyperesthesia  due  to 
hydrochloric  acid,  10  drops  of  the  dilute  acid  ingested 
while  fasting  causes  epigastralgia,  which  is  relieved  by 
sodium  bicarbonate. 

Rinsing  out  the  stomach  with  a  i  per  cent,  solution 
of  glacial  acetic  acid  closes  the  pylorus,  and  if  there  is  a 
positive  reaction  of  blood  in  the  syphoned  fluid,  it 
speaks  for  a  gastric  in  lieu  of  a  duodenal  ulcer.97 

The  heart  reflex  (page  199),  is  abolished  by  atropin  and 
accentuated  by  pilocarpin.  Thirty  minutes  after  an  injec- 
jection  of  pilocarpin  (gr.  i-io),  the  heart  reflex  measured 
4  cm.,  after  irritating  the  precordial  skin,  whereas  before 
the  injection,  like  irritation  elicited  a  reflex  measuring  2  cm. 

In  several  instances  when  it  was  impossible  to  elicit  the 
heart  reflex,  the  latter  could  be  demonstrated  after  an  in- 
jection of  pilocarpin. 

The  majority  of  cases  of  heart-block  (Adams-Stokes 
syndrome),  are  caused  by  lesions  of  the  auriculo- ven- 
tricular bundle,  but  there  are  also  neurogenic  forms  due 
to  vagus-hypertonia.  Atropin,  which  paralyzes  the  vagi, 
removes  the  block  in  the  neurogenic,  (pulse-rate  becomes 
rapid),  but  not  in  the  myogenic  forms.  Atropin  increases 
the  pulse-rate  in  bradycardia  due  to  direct  or  reflex 
excitation  of  the  vagus.  Aconite  tincture  slows  the  heart 
by  vagus-stimulation  and  if  it  slows  the  pulse  in  tachy- 
cardia, vagus-hypotonia  is  present. 

Vagus-stimulation  not  only  slows  the  heart-rate,  but 
creates  irregularities  in  rhythm.  If  this  vagus  influence 

454 


Pharmacologic     Methods 

is  eliminated  by  atropin  and  arrhythmia,  disappears,  the 
neurogenic  nature  of  the  irregularity  is  demonstrated. 

One  may  physiologically  block  a  host  of  reflex  cardiac 
anomalies  by  an  adequate  dose  of  atropin.  Thus,  a  case 
of  angina  pectoris  vasomotoria  may  be  cited  with  the 
following  signs:  heart  symptoms,  chest-pressure  and  fear 
ensuing  from  exposure  to  cold.  Here,  the  peripheral 
vasoconstriction  due  to  cold  by  increasing  blood  pressure 
stimulates  the  depressor  nerve,  which  in  turn  by  acting  on 
the  vagus  causes  cardiac  signs.  By  paralyzing  this 
physiologic  chain  with  atropin,  the  hands  may  be  dipped 
into  ice-water  without  subsequent  symptoms,  but  the 
latter  reappear  after  the  effects  of  atropin  have  evan- 
esced.88 

The  lung  reflexes*  (page  294  et  seq.*),  are  mediated  by 
vagal  action.  Thirty  minutes  after  an  injection  of  atropin 
(gr.  1-60),  both  lung  reflexes  are  absolutely  abolished. 

It  is  well  known  that  small  doses  of  pilocarpin  are 
almost  exactly  antagonistic  in  their  action  to  atropin, 
and  this  applies  in  all  cogency  to  their  action  on  the 
vagus. 

After  an  hypodermatic  injection  of  pilocarpin  (gr. 
i -i o),  one  may  note  an  exaggeration  of  both  lung  reflexes. 

Thus,  before  the  injection  of  pilocarpin,  the  lower 
lung-border  posteriorly  could  be  made  to  descend  (lung 
reflex  of  dilatation),  4  cm.  after  cutaneous  irritation, 
whereas,  after  the  injection,  the  border  in  question 
descended  7  cm. 


*In  a  recent  work  by  Leonard  Hill  (Further  advances  in  Physiology),  the  following 
obscure  observation  is  made:  "Even  now  most  medical  writers  ascribe  the 
reflex  contraction  of  the  lung  (Abrams'  reflex),  which  follows  any  stimulation 
of  the  chest-wall  to  the  action  of  the  bronchial  musculature.  It  is  more  prob- 
able that  the  retraction  of  the  lung  is  due  to  a  reflex  contraction  of  the  .muscu- 
lature of  the  body- wall."  Misconception  concerning  the  lung  reflex  is  due  to 
the  failure  to  recognize  two  distinct  lung  reflexes  and  to  properly  interpret 
their  rationale. 

455 


Spondyloth     e    r    a    p    y 

The  lung  reflex  of  contraction  before  the  injection 
lasted  20  seconds,  whereas,  after  the  injection,  it  lasted 
fully  one  minute. 

After  an  hypodermatic  injection  of  8  minims  of  a 
i :  1000  adrenalin  chlorid  solution,  the  following  phe- 
nomenon was  observed:  After  cutaneous  irritation,  the 
lower  lung  border  instead  of  descending  as  in  the  norm 
(lung  reflex  of  dilatation),  receded  from  2  to  4  cm.  In 
other  words,  cutaneous  irritation  elicited  the  lung  reflex 
of  contraction  in  lieu  of  the  counter  reflex  of  dilatation. 

If  one  accepts  the  prevailing  opinion  that,  asthma 
consists  essentially  of  a  spasmodic  constriction  of  the 
bronchioles,  then  an  appropriate  dose  of  atropin  which 
paralyzes  the  bronchial  musculature  through  its  action 
on  the  motor  endings  of  the  vagus,  must  invariably 
inhibit  an  asthmatic  paroxysm. 

Here,  the  action  of  atropin,  as  some  assume,  is  not 
caused  by  a  dilatation  of  the  bronchi,  because  the  action 
of  the  drug  is  to  paralyze  the  dilator  as  well  as  the  con- 
strictor fibers  of  the  bronchial  musculature. 

Atropin  in  sufficiently  large  doses  is  one  of  the  most 
satisfactory  drugs  in  asthma,  and  aside  from  its  action 
in  inhibiting  bronchospasm,  it  diminishes  secretion, 
reduces  the  sensitiveness  of  the  mucous  membranes  to 
reflexes,  and  stimulates  the  respiratory  center. 

Now,  as  a  matter  of  fact,  all  asthmatic  paroxysms  do 
not  yield  to  atropin,  hence  one  is  constrained  to  conclude 
that  bronchospasm  is  not  the  invariable  concomitant  of 
asthma.  There  may  be  a  hyperemia  of  the  bronchial 
mucosa  analogous  to  urticaria,  a  swelling  of  the  same 
mucosa,  or,  even  an  exudative  bronchiolitis. 

Determining  the  tonus  of  the  lung  reflex  of  contraction 
is  an  important  test  in  differential  diagnosis.  In  asthma 
due  to  a  defective  bronchial  musculature,  the  lung  reflex 
of  contraction  cannot  be  elicited. 

A  supposed  spasmodic  factor  in  the  pathology  of 
pulmonary  diseases  must  yield  to  atropin,  and  in  this 
sense  atropin  is  of  diagnostic-therapeutic  value. 

456 


Pharmacologic     Methods 

Adrenalin  chlorid  (in  doses  from  8  to  15  minims 
hypodermatically  of  the  1:1000  solution),  is  one  of  the 
most  efficient  agents  in  inhibiting  an  attack  of  asthma. 

The  action  of  this  drug  was  discovered  by  Kaplan 
and  Bullowa,  and  it  may  truly  be  regarded  as  a  specific  in 
arresting  many  paroxysms  of  asthma. 

As  noted  by  the  investigations  of  the  writer,  adrenalin 
chlorid  evokes  the  lung  reflex  of  contraction  which  per- 
mits the  longitudinal  fibers  of  the  bronchial  musculature 
to  expel  the  residual  air  imprisoned  by  the  spasm  of  the 
circular  fibers.* 

It  is  furthermore  evident  that,  in  our  employment  of 
drugs  in  the  treatment  of  asthma,  it  is  irrational  to  com- 
bine atropin  and  adrenalin  in  the  same  prescription. 

The  aortic  reflex  of  contraction  is  controlled  by  vagus- 
tone.  The  aorta  contracts  in  proportion  as  the  tone  of  the 
vagus  is  increased. 

Reference  to  Fig.  no,  shows  the  effects  of  pilocarpin 
(which  increases  vagus- tone),  on  an  aortic  abdominal  aneu- 
rysm,  and  although  I  have  never  found  it  necessary  to 
employ  this  drug  in  the  treatment  of  aneurysms,  it  will  aid 
the  physio-therapeutic  methods  as  a  synergist,  should  one 
encounter  cases  resistant  to  treatment. 

Atropin  will  inhibit  the  aortic  reflexes. 

The  effects  of  adrenalin  on  an  aneurysm  of  the  abdomi- 
nal aorta  are  shown  in  Fig.  in.  This  drug  dilates  an  aneu- 
rysm of  the  aorta. 

While  it  is  true  that  the  majority  of  vessels  are  con- 
stricted by  adrenalin,  the  effect  is  not  uniform.  Even  in 
the  norm,  dilator  effects  have  been  noted. 

The  physiologic  tonus  of  the  vagus  is  dependent  on  the 
thyroid  secretion.  When  the  latter  is  diminished  (hypo- 
thyroidism),  symptoms  of  cardiac  weakness  may  be  present, 

*Vide,  the  spasmo-paralytic  hypothesis  of  asthma  (page  308). 

457 


Spondyloth     e    r    a    p    y 


but  it  is  usually  an  increased  secretion  (hyperthyroidism), 
which  diminishes  vagus-tone.     As  a  rule,  in  hypothyroidism, 


Fig.  no. — Illustrating  the  effects  of  an  hypodermic  injection  of  pilocarpin 
(gr.  i-io)  on  an  aneurysm  of  the  abdominal  aorta.  A,  outline  of  aneurysm  by 
percussion  before  injection;  B  and  C,  aortic  reflexes  of  contraction  and  dilatation 
before  injection;  D,  contraction  of  aneurysm  by  the  action  of  pilocarpin  unaided 
by  the  elicitation  of  the  aortic  reflex.  The  degree  of  contraction  extends  from 
A  to  D.  E,  the  degree  of  contraction  of  the  aneurysm  after  the  use  of  pilocarpin 
aided  by  the  aortic  reflex  of  contraction  (extent  of  reflex  from  D  to  E). 

the  use  of  thyroid  extract  by  ameliorating  certain  symptoms, 
is  diagnostic.  In  hyperthyroidism,  antithyroidin  or  the 
antiserum  of  Beebe,  may  improve  the  condition.  It  is  well 
to  know  that  the  cardiac  signs  of  Basedow's  disease  are 
accentuated  by  ten  5-grain  doses  of  a  reliable  thyroid  pre- 
paration, lodothyrin  or  iodin  will  act  in  the  same  way 
and  intolerance  to  iodin  is  an  early  sign  of  hyperthyroidism. 

458 


Pharmacologic     M  e  t  h  o  d  s 

My  investigations  show  that,  even  in  the  norm,  reduction 
in  the  vagus-tone  may  be  demonstrated  after  a  few  doses  of 
thyroid  extract  by  methods  described  on  page  469.* 


Fig.  in. — Illustrating  the  effects  of  an  hypodermic  injection  of  8  minims  of 
adrenalin  chlorid  (1:1000)  on  an  aneurysm  of  the  abdominal  aorta,  i,  area  of 
aneurysm  by  percussion  before  the  injection;  2,  aortic  reflex  of  dilatation  before  the 
injection;  3,  area  of  aneurysm  by  percussion  after  the  injection  which  persisted  for 
an  hour;  4,  aortic  reflex  of  dilatation  after  the  injection. 

*In  phthisis,  the  author  has  found  the  vagus  to  be  in  a  condition  of  hypertonicity 
as  far  as  the  pulmonary  branches  are  concerned  and  he  has  used  thyroid  ex- 
tract (with  poor  results)  in  reducing  such  tonicity.  Thus,  in  one  patient,  be- 
fore giving  the  extract  in  five  grain  doses  thrice  daily,  the  lower  lung-border 
descended  5  cm.  (after  pressure  on  either  side  of  the  yth  cervical  spine). 
After  the  first  day,  it  descended  only  2  cm.,  on  the  second  day,  i  cm.,  and  on 
the  third  day,  .6  cm. 

459 


Spondyloth    e    r    a    p    y 

Inaccuracy  of  thyroid  medication  is  due  to  variations 
in  the  iodin-content  of  the  different  preparations  on  the 
market  and  to  the  fact  that  the  weight  of  the  tablets  is 
based  on  different  standards.  If  the  preparation  is 
reliable,  it  will  be  shown  by  the  progressive  immobility 
of  the  lower  lung-border  after  vagus-stimulation  (page 
459).  The  latter  test  is  so  simple  and  reliable  that  the 
author  suggests  as  a  field  for  pharmaco-clinical  research, 
the  action  of  different  drugs  on  vagus-tone. 

Bromids  reduce  the  excitability  of  the  motor  area  in  the 
cerebral  cortex  and  they  also  act  on  the  motor  and  sensory 
columns  of  the  cord  by  reducing  their  motor  and  sensory 
conductivity.  They  reduce  all  vagal  reflexes  and  are  val- 
uable in  diagnosis. 

To  get  the  effect  of  bromids,  or  for  that  matter,  any 
other  drugs,  we  must  push  them  to  saturation,  until  the 
border-line  of  toxicity  and  physiologic  action  is  reached. 
In  the  use  of  bromids  we  have  attained  our  object  for 
diagnostic  or  therapeutic  purposes  when  the  palate  reflex 
is  lost.  The  pharyngeal  reflex  may  even  be  abolished  in 
the  norm,  hence  this  reflex  is  only  of  value  if  tested  prior 
to  the  administration  of  the  bromids.  When  the  period 
of  intoxication  with  bromids  is  reached,  there  is  myd- 
riasis  and  loss  of  pupillary  reflex  to  light  and  accom- 
modation. Nervous  dyspeptics  show  improved  digestion 
after  bromids  have  been  used  in  large  doses  for  several 
days.  This  therapeutic  test  enables  us  to  differentiate 
gastric  symptoms  dependent  on  lesions  of  the  viscus 
from  those  caused  by  an  exhausted  nervous  system. 

High  blood-pressure  is  often  maintained  as  a  result 
of  augmented  tonus  of  the  vasomotor  center  and  is  quite 
independent  of  vascular  disease.  It  is  essentially  a  ner- 
vous phenomenon  and  usually  due  to  psychic  stimulation 
(psychogenic  hypertension).  Such  cases  do  not  respond 
to  the  author's  method  of  concussion  (page  249),  but 
yield  to  bromids,  as  indicated  on  page  247. 

460 


Hypertension 

Respecting  hypertension,  the  author  finds  that  better 
results  are  achieved  by  concussing  the  region  between 
the  third  and  fourth  dorsal  spines,  in  lieu  of  the  second 
and  third  dorsal  spines  as  described  on  page  247,  when 
the  high  blood-pressure  is  not  associated  with  cardiac 
insufficiency.  Hypertension  is  mediated  by  the  vagus 
and  pressure  at  the  point  indicated  diminishes  vagus- 
tone  and  augments  the  quantity  of  blood  in  the  splanch- 
nic vessels.  The  latter  may  be  demonstrated  by  the 
areas  of  dulness  on  the  abdomen  (vide  Fig.  103),  sequen- 
tial to  pressure.  Concussion  of  the  four  lower  dorsal 
spines  will  likewise  cause  the  areas  of  abdominal  dulness 
(Fig.  103),  but  if  pressure  is  executed  synchronously  at 
the  yth  cervical  spine  (which  increases  vagus-tone),  no 
areas  of  dulness  can  be  elicited.  This  shows  that  the 
centers  of  the  cord  corresponding  to  the  four  lower  dorsal 
vertebrae  are  subsidiary  to  the  dominant  influence  of 
the  vagus. 

Dr.  H.  C.  Sawyer  contributes  the  following  report 
concerning  a  case  of  hypertension:  "Woman,  60  years 
of  age,  blood-pressure  210  mm.,  reduced  to  160  mm., 
after  several  months  treatment  at  a  sanatorium.  When 
treatment  by  concussion  was  commenced  pressure  was 
1 80  mm.  Treatment  by  concussion  thrice  weekly 
reduced  pressure  to  138  mm.,  and  below,  and  has  con- 
tinued so  over  a  period  of  several  months. 

The  author  again  emphasizes  the  fact  referred  to  on 
page  248,  viz.,  that  in  hypertension  caused  by  a  failing 
heart,  reduction  in  pressure  can  only  be  achieved  by 
concussion  of  the  7th  cervical  spine. 

All  emotions  directly  influence  the  heart  and  the 
caprices  of  the  organ  with  its  protean  symptoms  may  be 
subdued  by  bromids.  Any  neurosis  embraces  the  entire 
field  of  pathology  and  this  applies  in  all  cogency  to  the 

heart. 

Rest  and  a  few  doses  of  morphin  are  capable  of 
completely  altering  the  picture  of  a  cardiac  disease. 


461 


Spondyloth     e    r    a    p    y 

VAGUS-TONE  AND  THE  SENSE  ORGANS. — If  both  nostrils 
are  firmly  packed  with  cotton  one  may  excite  the  vagus  reflex- 
ly  through  the  trigeminus.  Reference  to  this  fact  has  already 
been  made  on  page  297.  Even  though  a  paroxysm  is  not 
excited,  one  may  auscultate  after  the  cotton-test,  the  rales 
peculiar  to  asthma. 

It  is  only  recently,  however,  that  the  writer  has  noted 
that  the  hypertonicity  of  the  vagus  thus  elicited  includes 
practically  all  the  branches  of  the  vagus.  Like  results 
follow  firm  pressure  on  the  posterior  part  of  the  external 
auditory  meatus  (supplied  by  the  auricular  branch  of  the 
vagus). 

If  one  cocainizes  both  nostrils  (5$  solution  suffices  in 
the  norm),  one  observes  the  following: 

1 .  Inhibition  of  the  visceral  tone  (page  45 1),  of  the 
liver,  spleen  and  heart. 

2.  Inhibition  of  the  stomach  reflex  and  the  lung 
reflex  of  dilatation.     The  lung  reflex  of  contraction 
and  the  heart  reflex  persist. 

With  these  facts  at  our  command,  one  need  no  longer 
equivocate  with  specious  hypotheses  in  explanation  of  the 
reflexes  of  the  cranial  nerves  (page  440). 

The  nose  is  a  very  important  reflex  center  and  must 
be  examined  as  a  routine  measure  in  determining  the 
etiology  of  many  diseases  of  vagal  origin.  All  kinds  of 
reflex  disturbances  including  headaches,  neuralgias, 
chorea  and  even  epilepsy,  may  be  due  to  a  nasal  anomaly 
and  by  treatment  of  a  naso-pharyngitis,  deflection  of  the 
septum,  enlarged  turbinates,  etc.,  it  is  possible  to  cure 
many  disturbances.  Reference  has  already  been  made 
to  the  diagnosis  of  emphysema  by  aid  of  cocain  (page  297). 
Asthma  is  often  of  nasal  origin  and  paroxysms  may  be 
inhibited  by  saturating  pledgets  of  cotton  with  a  10  per 
cent,  solution  of  cocain  and  then  introducing  one  into 

462 


Vagus  Tone  and  the  Sense  Organs 

each  nostril.  If  relief  is  obtained,  one  should  determine 
from  which  side  of  the  nose  the  paroxysm  is  excited. 
If,  for  instance,  after  cocainization  of  the  right  nostril,  the 
paroxysm  persists,  and  desists  only  after  its  application 
to  the  left  nostril,  one  is  occasionally  justified  in  con- 
cluding that  the  attack  is  provoked  by  some  abnormity 
of  the  nostril  on  the  left  side.  One  must  not  forget, 
however,  that  mild  attacks  of  asthma  may  be  annihilated 
by  cocain  to  the  nostrils  despite  the  fact  that  there  is  no 
asthmogenic  nasal  area.  Here  we  recall  the  fact  that 
cocain  anesthesia  of  the  nose  inhibits  the  lung  reflex  of 
dilatation  without  influencing  the  counter-reflex  of  con- 
traction. It  is  the  exaggeration  of  the  latter  reflex 
which  determines  the  jugulation  of  a  paroxysm.  When 
adrenalin  arrests  a  paroxysm  it  does  so  by  stimulation 
of  the  bronchoconstrictor  fibers  (page  457),  and  cocain 
(which  is  less  efficient),  acts  by  inhibiting  the  tonus  of 
the  bronchodilator  fibers,  thus  enabling  the  antagonistic 
fibers  to  have  unopposed  sway.  One  may  provoke 
sneezing,  cough,  dyspnea  or  an  asthmatic  paroxysm,  by 
touching  different  parts  of  the  nasal  mucosa  with  a 
probe.  Such  areas  cauterized  with  chromic,  trichlor- 
acetic  or  glacial  acetic  acid  may  prove  curative. 

The  following  are  susceptible  areas  of  the  nasal 
mucosa:  i.  The  anterior  portion  of  the  septum; 
2.  The  anterior  end  of  the  inferior  turbinate.  3.  Lat- 
eral wall  of  the  nose  slightly  above  the  region  of  the 
anterior  end  rof  the  middle  turbinate;  and  4.  Upper 
part  of  septum  about  the  tubercle. 

Irritation  of  the  mucosa  of  the  nasal  septum  opposite 
the  middle  turbinate  bone  will  evoke  an  arrhythmia,  of 
vagal  genesis.  Here  the  irritation  is  conveyed,  in- 
directly, to  the  vagus  by  the  trigeminus. 

If  the  nasal  mucosa  has  been  cocainized  its  irritation 
by  a  probe  will  not  evoke  arrhythmia. 

According  to  the  theory  of  Fliess,  dysmenorrhea  is  often 
associated  with  nasal  affections.     He  determines  such  asso- 

463 


Spondyloth     e    r    a    p    y 

ciation  by  noting  whether  the  pains  are  influenced  by 
cocainization  (10  to  20  per  cent.),  of  the  nasal  mucosa. 
Fliess  further  observes  that  when  the  hyperesthetic  areas  in 
the  nose  are  irritated  with  a  probe,  the  pains  of  dysmen- 
orrhea  can  be  provoked.  The  latter  observation  was  made 
by  Fliess  to  contravene  the  assumption  of  others,  that  his 
results  were  due  to  suggestion  in  hysterical  subjects,  and 
that  equally  good  results  could  be  obtained  if  the  cocain  were 
applied  to  the  cervix,  rectum,  or  some  other  mucous  surface. 
My  observations  show  that  the  proponent  and  his  op- 
ponents are  equally  right  and  wrong.  If  one  first  elicits  the 
reflex  of  the  uterus  (page  358),  in  a  normal  subject  and  then 
cocainizes  the  nostrils  with  a  5  per  cent,  solution  of  cocain, 
the  uterus  reflex  cannot  be  provoked  during  the  action  of 
the  cocain. 

Furthermore,  cocain-anesthesia  of  any  other  mucosa 
is  equally  effective  in  abolishing  the  uterus  reflex.  In 
other  words,  anesthesia  of  a  peripheral  area  diminishes 
vagus-tonus.  When  Fliess  excites  dysmenorrheal  pains 
by  probing  the  nose,  he  merely  augments  vagus-tone. 

When  cocain  solution  (5%)  is  instilled  into  the  eyes 
all  the  vagal  reflexes  are  temporarily  abolished. 

We  can  now  understand  why  Koblauck  finds  that 
nasal  cocainization  will  temporarily  inhibit  labor  pains, 
and  that  applications  of  adrenalin  will  exgite  them. 

Siegmund  finds  that  gastric  pains  are  inhibited  by 
the  nasal  application  of  a  20  per  cent,  solution  of  cocain, 
which  he  considers  diagnostic  and  he  likewise  establishes 
by  the  same  diagnostic-therapeutic  method,  the  relation 
between  the  nose  and  the  genito-urinary  apparatus 
(enuresis  and  masturbation). 

It  will  be  evident  to  the  reader,  from  what  has  pre- 
ceded, that  the  method  of  nasal  cocainization  proves 
nothing.  It  is  only  one  of  the  many  methods  for  dimin- 
ishing vagus-tone.  By  cocainizing  the  urethra,  I  find 
that  one  can  inhibit  the  various  visceral  reflexes. 

464 


Vagus  Tone  and  the  Sense  Organs 

As  we  shall  learn  later,  diminished  vagus-tone  may 
be  effected  by  paravertebral  pressure  (page  467),  and, 
after  this  manner,  it  is  my  routine  practice  to  inhibit  the 
motor  and  sensory  reflexes  of  the  vagus. 

The  foregoing  observations  of  the  author  lead  one  to  a 
consideration  of  the  interesting  physiologic  problem,  viz., 
whether  the  doctrine  of  specific  nerve  energies  applies  to  the 
muco-cutaneous  nerves,  i.  e.,  whether  there  are  specific 
nerve  fibers  giving  only  their  own  quality  of  sensation. 
This  view  is  supported  by  Donaldson,  who  found  that  when 
cocain  is  applied  to  the  nose  or  throat,  the  senses  of  pain 
and  pressure  are  destroyed,  leaving  those  of  heat  and  cold. 

My  observations  show  a  very  important  clinical  fact,  viz., 
that  there  are  specific  muco-cutaneous  nerves  which  preserve 
the  tone  of  the  viscera  and  that  others  exist  which,  when  irri- 
tated, diminish  visceral  tone  (page  544). 

The  facts  thus  elicited  by  clinical  physiology  must  sub- 
stitute the  observations  of  the  physiologist.  Visceral  tone 
is  therefore  the  resultant  of  not  one,  but  of  a  summation  of 
peripheral  sensory  stimuli,  and  that  the  continuity  of  tone 
may  be  blocked  by  annihilation  of  a  single  stimulus. 

It  is  for  the  foregoing  reason  that  one  is  able  to  confirm 
the  observations  of  Kast  and  Meltzer  (Foot-note,  page  58). 

There  is  yet  another  observation  to  which  attention  should 
be  directed,  viz.,  that  after  nasal  cocainization,  in  lieu  of  a 
uterus  reflex,  one  elicits  a  powerful  reflex  contraction  of  the 
vaginal  walls  (vaginal  reflex).  This  latter  observation  may 
be  utilized  in  toning  relaxed  vaginae.  Here  the  sinusoidal 
current  is  used  at  the  same  site  for  elicitation  of  the  uterus 
reflex. 

In  concluding  this  interesting  subject  of  nasal  re- 
flexes, let  us  recall  the  practical  fact  that,  impaction  of 
the  nares  with  cotton  will  accentuate  or  provoke  symp- 

465 


Spondyloth     e    r    a    p    y 

toms  of  problematic  nasal  genesis,  whereas  nasal  cocain- 
ization  will  inhibit  them. 

The  pharmacology  of  the  ocular  reflexes  is  dis- 
cussed elsewhere,  (page  498). 

PSYCHOVAGUS-TONE. — Psychic  influences  on  the  heart 
and  lungs  have  been  discussed  on  page  203,  and  it  is  import- 
ant to  demonstrate  such  influences  objectively.  Reduction 
of  vagus- tone  may  be  of  psychic  origin.  Physiologic  ex- 
periments show  that  in  fatigue  of  the  nervous  system,  the 
nerve-cells,  which  in  health  are  plump,  large,  and  with  easily 
demonstrated  nuclei,  become  small  and  shrunken  and  the 
nuclei  indistinct.  In  consequence  of  this  enervation  of  the 
nervous  system,  reflexes  are  with  difficulty  elicited  and  cure 
protracted. 

The  author  recalls  a  patient  with  a  thoracic  aneurysm 
referred  to  him  by  Dr.  A.  J.  Minaker.  Within  a  few 
treatments  such  cases  show  amelioration,  but  in  this  case 
the  final  beneficial  results  were  delayed  by  grief  following 
the  death  of  a  member  of  the  family.  Here,  it  was  noted 
that  during  the  period  of  grief,  there  was  a  considerable 
reduction  of  vagus-tone. 

Another  factor  is  involved  in  psychic  influences. 
Splanchnic  stimulation  increases  the  content  of  epine- 
phrin  in  the  blood  and  adrenal  secretion  is  under  the 
control  of  the  sympathetic  system.  There  is  reason  to 
believe  from  the  investigations  of  Cannon  and  De  La 
Paz84  that  emotional  excitement  stimulates  adrenal  secre- 
tion. It  is  evident  that  when  the  sympathetic  is  stimu- 
lated, the  tonicity  of  the  vagus  is  reduced.  Emotional 
disturbances  conduce  to  symptoms  suggestive  of  vagus- 
depression  and  sympathetic  irritation;  aortic-dilatation, 
inhibition  of  the  gastro-intestinal  apparatus,  rapid  heart, 
etc.  I  have  often  been  impressed  with  the  inconsistency 
of  our  conception  of  hysteria  as  a  disease  in  which  the 
will  controls  the  body  and  produces  morbid  changes  in 

466 


Paravertebral      Pressure 

its  functions.  The  fact  is,  the  symptoms  of  the  disease 
are  caused  by  stimulation  of  the  sympathetic  system  and 
the  latter  is  not  under  the  influence  of  the  will.  It  is 
equally  inconsistent  to  ask  such  patients  to  control  their 
symptoms  by  exercise  of  the  will. 

2.  PARA  VERTEBRAL  PRESSURE. — We  have  shown  under 
the  preceding  caption  that  pilocarpin,  increases  vagus-tone 
and  that  atropin  annihilates  it.  That  adrenalin,  by  stimu- 
lating the  sympathetic  fibers,  puts  the  latter  in  a  state  of 
increased  tonus,  thereby  resulting  in  a  relative  reduction  of 
vagus-tonus. 

We  shall  now  endeavor  to  show  that  augmentation  and 
reduction  of  vagus-tonus  may  be  obtained  in  a  simplified 
and  more  expeditious  manner  by  paravertebral  pressure. 
The  excitation  of  visceral  reflexes  by  spinal  pressure  has 
already  been  noted  on  page  169. 

The  points  of  exit  of  the  spinal  nerves  are  relatively 
superficial.  Thus  in  a  number  of  measurements,  I  found 
the  exit  at  a  point  corresponding  to  the  yth  cervical  vertebra 
to  be  at  a  depth  of  2.6  cm.  (approximate  only),  almost  in  a 
direct  line  with  the  corresponding  spinous  process  and  the 
distance  between  the  two  exits  corresponded  to  an  average 
width  of  2  cm. 

At  the  first  lumbar  vertebra,  4.5  cm.  represented  the 
depth  and  5  cm.,  the  width  of  the  exits  on  either  side. 

For  making  pressure  I  employ  the  simple  apparatus 
shown  in  Fig.  112.  The  prongs  of  the  instrument  are  separ- 
ated by  a  distance  of  5  cm.  If  one  makes  pressure  (the 
prongs  approximating  the  intervertebral  foramina  on  both 
sides),  at  a  point  corresponding  to  the  seventh  cervical  spine, 
•vagus- tone  is  increased  and  decreased  or  abolished  when 
pressure  is  applied  at  a  point  between  the  third  and  fourth 
dorsal  spines.  Pressure  is  maintained  for  about  one  minute. 

467 


Spondyloth     e     r    a    p    y 

The  author  assumes  that  at  the  former  point,  the  pressor, 
and  at  the  latter  situation,  the  depressor  fibers  of  the  vagus 
are  stimulated  (page  232.) 


Fig.  112. — The  instrument  with  two  prongs  (Radicular pressor}  is  employed  in 
diagnosis  and  treatment  for  making  bilateral  pressure  on  the  roots  of  the  spinal 
nerves  at  their  exit  from  the  intervertebral  foramina.  The  instrument  with  a  single 
prong  is  used  for  demonstrating  areas  of  paravertebral  tenderness  (vide,  page  66). 

The  depressor  nerve  is  the  most  important  centripetal 
nerve  of  the  heart,  and  while  existing  as  a  separate  anatomic 
structure  in  warm-blooded  animals,  its  homologue  has  been 

468 


Paravertebral      Pressure 

traced  in  the  human  with  central  connections  in  the  vagus 
and  endings  in  the  walls  of  the  ventricle. 

Fig.  113  shows  the  origin  of  the  depressor  nerve  in  the 
rabbit. 


Fig.  113. — Scheme  of  the  cardiac  nerves  in  the  rabbit  (Landois  and  Stirling). 
P,  pons;  M,  medulla  oblongata;  VAG,  vagus;  SL,  superior,  IL,  inferior  laryngeal; 
sc,  superior  cardiac  or  depressor;  ic,  inferior  cardiac  or  cardio-inhibitory;  H,  heart. 

METHODS  OF  INCREASING  VAGUS-TONE. — Elsewhere  (page 
228),  reference  has  been  made  to  maneuvers  for  exciting 
the  tone  of  the  vagus  and  the  practical  ones  may  be  recapitu- 
lated as  follows:  i.  Pressure  at  the  yth  cervical  spine  by 
aid  of  the  instrument  shown  in  Fig.  112.  2.  Position  of  the 
head,  as  shown  in  Fig.  65,  and  so  maintained  while  observing 
the  vagal  phenomena.  3.  Pressure  in  an  intercostal  space. 

Preference  is  accorded  to  the  first  method  when  an 
assistant  is  present,  although  when  one  is  dealing  with  an 

469 


a    p    y 


intelligent  patient,  the  second  method  suffices.  Even  with- 
out an  assistant,  one  can  demonstrate  the  exalted  vagal 
reflexes,  if  pressure  is  made  at  the  yth  cervical  spine  with  the 
instrument,  or  in  an  intercostal  space  (firm  pressure),  with 
the  finger,  and  one  proceeds  at  once  with  percussion  (some 
visceral  reflexes  do  not  exceed  the  duration  of  a  minute). 
However,  one  may  note  in  the  following  table  the  duration 
of  the  lung  reflex  of  dilatation  when  pressure  is  made  for 
one-half  minute.  Insomuch  as  the  degree  and  duration  of 
descent  of  the,  lower  lung-border  \s>  most  conveniently  utilized  in 
testing  vagus-tone,  a  comparison  of  methods  is  cited  in  the 
normal  subject: 

COMPARISON  OF  METHODS. 


METHOD 

TIME  IN 
APPLICATION 
OF  METHOD 

DEGREE  OF  DESCENT 
OF  THE  RIGHT  LOWER 
LUNG-BORDER 
POSTERIORLY 

DURATION 
OF 
DESCENT 

Pressure  corresponding  to  both 
sides  of  the  yth  cervical  spine  .  . 

One-half 
minute. 

5  cm. 

9  minutes 

Forcible  extension  of  the  neck. 
(Fig.  65). 

One-half 
minute. 

4  cm. 

3i  minutes 

Pressure  in  an  intercostal  space. 

One-half 
minute 

3  cm. 

i   minute 

Direct  concussion  of  the  yth  cervi- 
cal spine. 

One-half 
minute. 

4  cm. 

2}  minutes 

Sinusoidal  current  (rapid)  with 
poles  on  either  side  of  the  yth 
cervical  spine. 

One-half 
minute. 

5.  5  cm. 

2^   minutes 

High-frequency  current  on  either 
side  of  yth  cervical  spine  with  a 
double  vacuum  electrode  (Fig. 
100). 

One-half 
minute. 

5-  5  cm. 

2\   minutes 

VAGAL-PHENOMENA. — During  the  time  pressure  is  made 
at  the  yth  cervical  spine  with  the  instrument  shown  in  Fig.  112, 
one  notes  the  following: 

470 


V  a   g   a    I       Phenomena 

1.  Augmented  tone  of  the  heart,  aorta,  lungs,  stomach, 
liver,  spleen  and  intestines,  manifested  by  increased  dulness 
of  the  organs  in  question  and  better  definition  of  their 
borders.* 

Reference  has  already  been  made  to  visceral-tone 
(page  451),  but  to  further  appreciate  the  importance  of 
this  subject,  let  us  refer  to  the  heart.  During  diastole,  the 
walls  of  the  heart  are  relaxed  but  this  diastolic  relaxation 
varies  with  the  tonicity  of  the  heart-muscle.  Fibers  exist 
in  the  vagus  of  the  frog,  which,  when  stimulated,  increase 
the  tone  of  the  myocardium.  When  one  makes  pressure 
as  above,  the  cardiac  muscle  normally  relaxed  becomes 
rigid  (diastolic  rigidity).  I  employ  this  method  for 
facilitating  the  percussion  of  the  heart  and  in  testing  its 
tone.  If  the  myocardium  is  normal,  the  precordial  dul- 
ness is  accentuated  after  the  above  maneuver,  whereas, 
if  diseased  (diminished  tone),  the  degree  of  dulness  is 
unchanged.  Forcible  extension  of  the  neck  may  likewise 
be  utilized  in  testing  the  tone  of  the  organs  specified  and 
determining  their  borders  by  regional  percussion 

2.  Contraction  of  the  pupils  (this  is  not  constant). 

3.  Closure  of  the  cricp- thyroid  space. 

The  latter  phenomenon  is  best  elicited  when  the 
finger-tip  is  placed  at  the  side  of  the  crico-thyroid  mem- 
brane. Pressure  brings  out  the  phenomenon  best.  If 
not  detected  easily  have  the  assistant  make  intermittent 
pressure  at  the  yth  cervical  spine.  The  crico-thyroid 
muscle  is  supplied  by  the  superior  laryngeal  (branch  of 
the  vagus)  nerve,  and  it  produces  tension  and  elongation 
of  the  vocal  cords.  An  hysterical  paralysis  of  the  vocal 

*In  association  with  the  augmented  visceral  tone,  there  is  visceral  contraction,  and 
this  contraction  is  greater,  e.  g.,  of  the  stomach  at  the  yth  cervical  spine  than 
at  the  upper  lumbar  spines  (page  316).  Thus,  the  degree  of  stomach-contrac- 
tion when  the  first  three  lumbar  spines  are  concussed  is  only  2  cm.,  but  4  cm. 
after  concussion  of  the  7th  cervical  spine.  The  same  observation  applies  to  the 
spleen. 

471 


Spondyloth     e    r    a    p    y 

cords  may  be  diagnosed  objectively  by  closure  of  the 
crico-thyroid  space  by  the  suggested  maneuver. 

4.  Eosinophilia. 

5.  Hyperesthesia  of  the  fauces. 

6.  Descent  of  the  lower  border  of  the  lung  (lung  reflex 
of  dilatation). 

7.  Diminution  in  volume  of  pulse  and  slowing  to  extinc- 
tion. 

It  is  more  convenient  to  select  the  lower  border  of  the 
lung  posteriorly  on  either  side.  The  lower  border  is  first 
determined  by  percussion,  after  which  pressure  is  made 
for  one-half  minute  and  the  border  again  determined. 
In  the  norm  the  descent  is  about  4  cm.  In  vagus-hyper- 
tonia,  it  may  descend  6  cm.,  and  in  hypotonia,  it  may 
descend  only  2  cm.,  or  not  at  all.  Pressure  between  the 
spines  of  the  third  and  fourth  vertebrae  causes  the  lower 
lung-border  to  recede.  Increased  vagus-tonus  is  gener- 
ally associated  with  a  low  lung-border  and  its  converse 
condition  with  a  high  border. 

METHODS  FOR  DECREASING  VAGUS-TONUS. — i.  Pressure 
with  the  instrument  (Fig.  112),  at  a  point  between  the  third 
and  fourth  dorsal  spines. 

2.     Pressure  behind  both  ears. 

During  the  time  such  pressure  is  made  one  notes  the 
following: 

1.  Diminished  tone  of  the  heart,  aorta,  lungs,  stomach, 
liver,  spleen  and  intestines. 

2.  Annihilation  of  the  reflexes  of  the  lungs,  stomach, 
heart,  aorta,  spleen  and  intestines. 

2.  Pupillary  dilatation. 

3.  Widening  of  the  crico-thyroid  space. 

4.  Anesthesia  of  the  fauces. 

472 


Pressure     Behind     Both     Ears 

5.  Ascent  of  the  lower  lung- border  (lung  reflex  of  con- 
traction. 

6.  Pulse  diminished  in  volume  and  rapidity  increased. 

In  this  connection,  it  is  necessary  to  note  the  approx- 
imation of  the  sites  for  increasing  vagus- tone  (yth  cervical 
spine)  and  for  diminishing  it  (between  the  3d  and  4th 
dorsal  spines).  A  physician  whose  results  were  futile  in 
the  treatment  of  an  aneurysm  by  concussion  made  the 
egregious  error  of  employing  a  large  concussor  which 
embraced  simultaneously  the  'areas  for  increasing  and 
diminishing  vagus-tone. 

2.  PRESSURE  BEHIND  BOTH  EARS. — The  observations  of 
Milligan  and  Home  have  been  confirmed  by  others :  pressure 
applied  to  the  mastoid  processes  generally  relieves  pain  (due 
to  faucial  inflammation),  in  swallowing.  Hald  explains  the 
effect  as  due  to  counter-irritation  of  the  skin  at  a  point 
where  the  sensory  nerves  are  closely  connected  (centrally), 
with  the  sensory  nerve-supply  of  the  tonsils 

In  investigating  this  subject,  the  author  finds  that 
pressure  between  the  3d  and  4th  dorsal  spine  is  the  more 
efficient  of  the  two  methods.  In  both  methods,  dysphagia 
(whether  due  to  faucitis  or  esophagismus),  is  combated 
by  inhibition  of  the  sensory  functions  of  the  vagus. 
Even  in  the  norm,  one  may  anesthetize  the  throat  for 
practical  purposes  (laryngoscopic  examination  or  intro- 
duction of  a  stomach-tube),  by  firm  bilateral  pressure  for 
one  or  two  minutes  at  the  site  noted  (between  the  3d  and 
4th  dorsal  spines).  The  anesthesia  however,  is  limited 
in  duration  but  it  may  be  prolonged  by  resumption  of 
pressure.  In  pressure  behind  both  mastoids  the  same 
vagal  phenomena  ensue  as  were  cited  when  pressure  is 
made  between  the  third  and  fourth  dorsal  spines.  By 
bilateral  mastoid-pressure  one  probably  compresses  the 

473 


Spondylotherapy 

auricular  branch  of  the  vagus  which  appears  cutaneously 
behind  the  ear. 

One  must  note  another  fact  when  vagus-tone  is 
diminished  by  pressure  between  the  3d  and  4th  dorsal 
spines,  viz.:  dilatation  of  certain  viscera.  Thus,  an 
aneurysm  which  shows  a  diameter  of  4  cm.,  by  percussion 
is  reduced  to  i  cm.  when  vagus-tone  is  increased  by  pres- 
sure at  the  yth  cervical  spine  and  increased  to  7  cm., 
when  vagus-tone  is  decreased.  Pressure  or  concussion  of 
the  region  for  reducing  vagus-tone,  produces  greater 
dilatation  of  the  aorta  than  the  conventional  site  for 
eliciting  the  aortic  reflex  of  dilatation  (page  256).  Thus, 
an  aneurysm  measures  4.8  cm.  in  the  transverse  diam- 
eter; concussion  of  the  9th-i2th  dorsal  spines  gives  a 
measurement  of  8  cm.,  and  10  cm.,  after  concussion  be- 
tween the  3d  and  4th  dorsal  spines. 

THERAPEUTIC  RESULTS. — Cures  show  the  nature  of 
diseases.  Draper  made  the  sapient  observation  that: 
"Mastery  of  all  the  sciences  upon  which  medicine  is  founded 
does  not  make  the  physician  .  .  .  until  he  learns  how 
to  construct  out  of  them  the  special  art  which  enables  him 
to  cure  disease."  Broussais  observed  that  the  real  physician 
is  one  who  cures.  A  story  is  related  of  an  American  phy- 
sician who  was  shown  through  a  large  pathologic  laboratory 
in  Paris,  and  was  wearied  looking  at  shelf  after  shelf  loaded 
with  pickled  specimens  of  organs  and  tissues  from  people 
long  since  dead.  At  last  he  turned  to  the  great  pathologist 
and  said:  "Great  God!  where  are  the  people  you  have 
cured?" 

It  is  difficult  to  charm  ache  with  air,  and  agony  with 
words,  and  unless  we  call  a  halt  on  scientific  medicine  ( ?) 
we  shall  soon  regard  it  as  a  misdemeanor  should  the  patient 
be  so  presumptuous  as  to  demand  a  cure. 

A  short  time  back,  the  author  sent  to  a  leading  German 

474 


Therapeutic     Results 

medical  journal,  a  report  of  40  cases  of  aortic  aneurysm, 
symptomatically  cured.  Most  men  will  agree  that  the  cure 
of  aneurysms  should  be  considered  one  of  the  greatest  con- 
tributions ever  made  to  scientific  medicine.  The  report, 
however,  was  refused  publication,  based  on  the  assumption 
that,  insomuch  as  aortic  aneurysms  were  incurable,  any 
reports  to  the  contrary  were  in  violation  of  our  accepted 
theories  concerning  the  pathology  of  the  disease. 

The  physio-therapeutic  methods  suggested  in  this  book 
for  inhibiting  or  exciting  visceral  reflexes  are  equally  available 
in  diminishing  or  increasing  vagus-tone.  In  the  application 
of  our  method,  whether  it  be  concussion,  pressure  or  electric- 
ity, we  must  always  remember  that  to  increase  vagus-tone, 
we  confine  ourselves  to  the  bilateral  paravertebral  area 
corresponding  to  the  yth  cervical  spine,  and  when  vagus-tone 
is  to  be  diminished,  the  site  of  election  is, between  the  3d 
and  4th  do?sal  spines.  Symptoms,  in  some  affections,  abate 
rapidly,  whereas  in  others  the  results  are  more  tardy.  We 
may  gauge  our  results  by  noting  the  degree  of  descent  and 
position  of  the  lower  lung-border. 

If  the  symptoms  do  not  abate  despite  the  augmentation 
or  decrease  of  vagus-tone,  then  vagus-tone  is  in  no  wise 
related  to  the  symptoms  (page  451). 

In  the  choice  of  the  method  to  be  employed,  the  physician 
can  determine  for  himself  the  one  most  effective  for  causing 
either  a  descent  (increased  vagus- tone),  or  ascent  (dimin- 
ished vagus- tone),  of  the  lower  lung-border. 

When  ability  is  lacking  in  this  regard,  then  concussion 
should  be  given  the  preference,  insomuch  as  it  is  easy  of 
application  and  generally  reliable.  Over-treatment  must  be 
avoided  to  prevent  exhaustion  of  the  reflexes. 

The  following  table  represents  the  degree  of  ascent  of 
the  lower  lung-border  after  different  methods  to  the 

475 


Spondyloth     e    r    a    p    y 

region  between  the  third  and  fourth  dorsal  spines  for 
decreasing  vagus-tone: 

CONCUSSION 2.3  cm. 

RAPID  SINUSOIDAL  CURRENT i.6  cm. 

SLOW  SINUSOIDAL  CURRENT 1.6  Cm. 

PRESSURE 1.6  cm. 

HIGH-FREQUENCY  CURRENT — No  ascent. 


Fig.  114. — Base-knob  for  executing  para  vertebral  pressure  or  eliciting  para- 
vertebral  tenderness 


The  duration  of  retraction  was  greatest  with  the  slow 
sinusoidal  current;  one  pole  applied  on  each  side  of  the 
spine  between  the  third  and  fourth  dorsal  vertebrae. 

In  many  instances  the  patient  is  provided  with  two 
ordinary  base-knobs  (Fig.  114),  and  he  is  instructed  to 
have  some  member  of  the  family  make  firm  pressure  four 
times  daily  on  either  side  of  the  spine  (corresponding  to 
the  area  to  be  influenced)  for  a  period  of  time  not  ex- 
ceeding one  minute.  To  protect  the  skin  and  to  locate 
the  site  of  pressure  the  physician  should  apply  a  narrow 
strip  of  adhesive  plaster. 

One  of  my  patients  suggested  screwing  the  base-knobs 
on  the  back  of  a  chair  or  into  a  wall  at  a  convenient 

476 


Therapeutic     Results 

height  and  by  bracing  the  feet,  the  patient  can  exert 
pressure  himself. 

In  locating  paravertebral  tenderness,  the  physician 
will  find  the  base-knob  very  convenient. 

Another  and  most  effective  method  which  can  be  em- 
ployed by  the  patient  at  home  for  increasing  vagus-tone,  is 
that  of  extending  the  muscles  of  the  neck,  as  shown  in  Fig.  65. 


Fig.  115. — Heart  reflex  elicited  by  the  method  of  extending  the  muscles  of  the 
neck  (vide,  Fig.  65).  The  amplitude  of  the  reflex  is  indicated  by  the  reduced  area 
of  cardiac  dullness  extending  from  without  to  within  the  nipple. 

This  may  be  executed  twice  or  thrice  daily,  and  about 
twenty  forcible  extensions  can  be  made  at  a  seance. 

In  affections  of  the  heart  and  other  diseases  caused  by 
diminished  tone  of  the  vagus,  my  patients  are  instructed  to 
execute  these  exercises  in  addition  to  treatment  at  my  office. 
The  effect  of  such  exercise  on  a  dilated  heart  is  noted  in 

Fig-  115- 

Fig.  116  represents  an  apparatus  for  applying  bilateral 
paravertebral  pressure.  Suspended  from  the  middle  bar  is 
a  suspension  apparatus  which  is  quite  independent  of  the 
other. 

477 


Spondyloth     e    r    a    p    y 


Suspension  Treatment,  when  first  advocated  for  loco- 
motor  ataxia,  was  employed  indiscriminately  and  soon 
passed  into  desuetude.  With  this  treatment  the  patient 


Fig.  116.  Apparatus  for  applying  bilateral  para  vertebral  pressure.  Adjusted 
to  the  bars  are  two  pieces  which  can  be  raised  or  lowered.  The  front  piece  is  pro- 
vided with  a  cushion  which  is  6xed  to  the  chest  with  a  screw  and  is  used  for  counter- 
pressure.  The  back  piece  is  provided  with  two  small  knobs  (barely  visible  in  the 
illustration),  which  are  fixed  over  a  definite  vertebral  area  and  by  means  of  a  screw 
any  degree  of  pressure  can  be  made.  Suspended  from  above  is  a  suspension  ap- 
paratus which  is  independent  of  the  other. 

is  suspended  in  a  Sayre  apparatus.  This  treatment  is 
still  used  by  the  author  as  an  invaluable  method  in  some 
cases  for  the  relief  of  pain,  bladder-disturbances  and 
impotency.  The  method  is  curative  when  pains  simu- 
lating lumbago  are  really  due  to  adhesions  in  the  verte- 

478 


Diseases  Caused  by  Vagus-Hypertonia 

bral  articulations.  Suspension  was  used  in  1829  by 
J.  K.  Mitchell,  of  Philadelphia,  for  affections  of  the  cord 
secondary  to  vertebral  disease.  The  investigations  of 
Motschutkowski,  show  that  during  suspension,  the  nerve- 
roots  pass  from  a  horizontal  to  an  almost  perpendicular 
position  and  the  cadaver  was  increased  in  length. 

I  have  found  that,  during  suspension,  the  tone  of  the 
viscera  is  augmented. 

It  is  for  the  latter  reason,  if  for  no  other,  that  suspen- 
sion may  be  regarded  as  a  valuable  method  of  treatment. 

Effects,  almost  equal  to  suspension  may  be  achieved 
by  having  the  patient  sit  on  the  floor  or  a  table  and  then 
forcibly  flexing  the  head  and  trunk  upon  the  thighs, 
while  the  lower  extremities  are  kept  straight. 

DISEASES   CAUSED   BY  VAGUS-HYPERTONIA  AND  VAGUS- 
HYPOTONIA 

DIABETES  MELLITUS. — The  great  majority  of  cases  of 
this  affection  observed  by  the  author  have  been  associated 
with  vagus-hypotonia,  and  he  has  treated  his  cases  by  the 
method  suggested  on  page  281.  Since  the  results  were  pub- 
lished on  page  283  he  has  encountered  a  group  of  cases 
yielding  better  results  and  even  though  no  symptomatic  cure 
was  effected  in  several  cases,  the  tolerance  for  carbohydrates 
was  augmented.  In  two  cases  with  a  pronounced  history  of 
heredity  (several  members  being  similarly  afflicted  with 
diabetes),  no  results  were  achieved.  The  only  restriction 
respecting  diet  was  the  avoidance  of  any  excess  of  carbo- 
hydrates. 

In  several  individuals  with  alimentary  glycosuria,  the 
assimilation  limit  for  carbohydrates  was  increased  by  aug- 
mentation of  vagus-tone  by  concussion.  The  test  employed 
was  that  of  Naunyn:  two  hours  after  a  breakfast  consisting 
of  a  roll  and  butter,  with  coffee,  100  grams  of  glucose,  given 

479 


Spondyloth     e    r    a    p    y 

in  solution,  ought  not  to  cause  a  glycosuria.  If  glycosuria 
ensues,  the  individual  shows  a  diminished  capacity  for  ware- 
housing carbohydrates  and  true  diabetes  may  eventually 
follow.  The  liver  is  the  probable  source  of  sugar  production 
and  is  in  turn  controlled  by  the  pancreas  and  suprarenals 
(the  pancreas  playing  the  role  of  inhibition,  and  the  supra- 
renals that  of  stimulation  in  sugar  production).  The  secre- 
tion of  the  thyroid  inhibits  the  function  of  the  pancreas  as  is 
demonstrated  in  the  tendency  to  glycosuria  in  hyperthy- 
roidism.  After  thyroidectomy,  the  inhibitory  influence  of 
the  pancreas  on  the  liver  is  so  powerful  that  it  is  almost 
impossible  to  produce  glycosuria.  Modern  writers  regard 
the  glycosuria  ensuing  from  puncture  of  the  medulla  to  be 
due  to  suprarenal  stimulation,  which  excites  the  liver  to  an 
increased  output  of  sugar.  The  puncture  of  the  medulla 
stimulates  the  left  sympathetic  nerve  and  this  stimulation  is 
transmitted  first  to  the  left  and  then  to  the  right  suprarenal. 
If  the  left  suprarenal  is  separated  from  the  left  sympathetic 
nerve,  glycosuria  does  not  follow  puncture  of  the  medulla. 

If  the  vagus-tone  is  normal,  adrenalin  (given  hypoder- 
matically),  will  not  cause  glycosuria,  nor  will  the  ingestion 
of  glucose  up  to  300  grams.  Atropin  diminishes  or  abolishes 
vagus-tone  and  in  individuals  with  reduced  vagus-tonus, 
even  small  doses  may  cause  glycosuria. 

One  also  knows  that  pilocarpin,  which  augments  vagus- 
tone,  will  suppress  glycosuria  from  adrenalin. 

In  several  instances  I  have  found  glycosuria  in  sus- 
ceptible individuals  to  follow  paravertebral  pressure  between 
the  3d  and  4th  dorsal  spines.  This  maneuver  abolishes  or 
diminishes  vagus-tone  (page  472). 

In  practically  all  of  my  diabetic  patients  I  have  found 
enlargement  of  the  liver  and  the  signs  of  diminished  tone  of 
the  splanchnic  circulation. 

4SO 


Diabetes      M   e    I   I    i   t   u    s 

Dr.  H.  C.  Sawyer  reports85  the  following  case  of  diabetes 
treated  according  to  the  method  of  the  author: 

"Female,  fifty-two  years  of  age,  and  weighing  about 
180  pounds  presented  herself  April  9,  1910,  with  a  history 
of  incessant  thirst  and  frequent  urination  owing  to  the  ex- 
cretion of  enormous  quantities  of  urine.  The  latter  at 
this  time  had  a  specific  gravity  of  1,040  and  contained 
eight  per  cent,  of  sugar;  the  reaction  for  diacetic  acid  was 
positive. 

The  following  represented  the  average  daily  menu 
prior  to  the  commencement  of  treatment  which  consisted 
of  daily  concussion  of  the  seventh  cervical  spine  of  an 
average  duration  of  about  ten  minutes:  Breakfast. — 
Coffee,  toast,  and  scrambled  eggs.  Luncheon. — Cold 
chicken,  chop,  asparagus,  potatoes,  and  several  slices  of 
bread.  Dinner. — Soap,  egg  salad,  chicken,  several 
slices  of  bread,  asparagus,  ice  cream,  and  coffee.  The 
foregoing  diet  was  permitted  during  the  treatment. 

Within  one  week,  polydipsia  and  polyuria  had  com- 
pletely evanesced,  but  sugar  continued  in  the  urine  vary- 
ing in  percentage  from  5  to  0.77  per  cent,  on  May  7,  1910. 

After  the  latter  date  and  up  to  the  present  time  of 
writing  (July  30,  1911.)  there  was  absolutely  no  trace  of 
sugar  in  the  urine  with  the  exception  of  one  day  when  it 
reappeared  temporarily  after  the  patient  partook,  at  a 
picnic,  of  a  bottle  of  root-beer  and  ingested  many  other 
elements  containing  an  excess  of  sugar. 

Comments. — The  reappearance  of  sugar  on  a  single 
day  was  of  no  moment  and  indicated  a  physiological 
glycosuria  which  occurs  in  certain  persons  of  apparently 
good  health  after  the  rapid  ingestion  of  an  excessive 
quantity  of  carbohydrates.  From  the  evidence  pre- 
sented, the  case  in  question  can  only  be  regarded  as  one  of 
true  diabetes  mellitus.  The  rationale  of  the  method  con- 
sists of  diminishing  the  quantity  of  blood  flowing  through 
the  liver  by  augmenting  the  tone  of  the  splanchnic  blood- 

481 


Spondyloth     e    r    a    p    y 

vessels  and  thus  improving  the  nutrition  of  the  hepatic 
cells  concerned  in  the  warehousing  of  carbohydrates. 

By  the  method  of  percussing  the  liver  as  suggested 
by  Abrams,  enlargement  of  the  organ  may  be  demon- 
strated in  diabetes  and  a  diminution  of  its  volume  may  be 
noted  after  a  single  concussion  seance.  The  latter  fact  is 
probably  due  to  a  diminished  volume  of  blood  in  the  liver 
and  is  not  a  true  liver  reflex  such  as  is  elicited  by  con- 
cussion of  the  spinous  processes  of  the  first  three  lumbar 
vertebrae. 

Twenty  seances  of  the  concussion  treatment  in  the 
foregoing  case  were  necessary  before  the  sugar  disap- 
peared from  the  urine." 

It  is  the  practice  of  the  author,  before  commencing 
treatment  to  get  the  urine  sugar-free  and  then  to  add, 
gradually,  small  quantities  of  carbohydrates  to  the  die- 
tary. 

DISEASES  OF  THE  THYROID  GLAND.— Organotherapy 
has  demonstrated  the  causal  relation  between  this  gland  and 
a  host  of  diseases.  It  has  already  been  shown  that  the 
physiologic  tonus  of  the  vagus  is  probably  dependent  on  the 
thyroid  secretion.  In  diseases  due  to  diminished  thyroid 
secretion  (hypothyroidism),  vagus-tonus  is  increased  and 
conversely  diminished  when  the  secretion  is  excessive 
(hyper  thyroidism) . 

HYPOTHYROIDISM. — Insufficiency  of  the  thyroid  gland 
may  be  recognized  by  the  tests  on  page  488,  et  seq.  The 
diagnostic-therapeutic  test  by  the  administration  of  thyroid 
is  equally  valuable.  Diseases  caused  by  hypersecretion  are 
aggravated,  and  those  due  to  hyposecretion,  are  ameliorated 
or  cured  by  thyroid. 

One  must  give  thyroid  to  obtain  physiologic  and  not 
toxic  effects  (thyroidism).  The  symptoms  of  thyroidism 
indicate  that  the  thyroid  dosage  must  be  reduced  or  inter- 
dicted. The  signs  of  thyroidism  are:  anorexia,  emaciation,. 

482 


Diseases    of  the    Thyroid    Gland 

perspiration,  insomnia,  headache,  nervous  excitement,  heart 
palpitation,  tachycardia,  tremors,  prostration,  etc.  Inso- 
much as  thyroid  diminishes  vagus-tone  (page  459),  it  is  not 
surprising  to  note  that  glycosuria  may  attend  its  adminis- 
tration. Thyroid  function  is  identified  with  the  metabolism 
of  carbohydrates,  insomuch  as  it  has  been  shown  that  the 
administration  of  thyroid  interferes  with  the  retention  or 
assimilation  of  carbohydrates.  Thyroid  should  never  be 
given  in  the  presence  of  symptoms  suggesting  exophthalmic 
goitre. 

The  dessicated  thyroid  is  a  yellow  powder  made  from 
the  thyroid  glands  of  sheep,  and  the  dose  varies  from  \  grain 
to  1 5  grains.  It  is  more  convenient  to  give  it  in  tablet  form, 
and  reliable  tablets  are  made  by  Merck,  Parke,  Davis  and 
Co.,  and  Burroughs  Wellcome  &  Co.  It  is  also  given  as 
the  raw,  fresh  gland  of  a  sheep,  on  bread,  beginning  with 
the  eighth  part  of  a  gland  and  gradually  increasing  the 
amount.  The  latter  mode  of  administration  is  indicated 
when  the  dried  preparations  cause  thyroidism.  Thyroid 
has  been  given  for  every  imaginable  disease,  but  there  are 
certain  affections  which  empiricism  has  taught  are  identified 
with  subsecretion  of  the  gland. 

In  children  hyposecretion  and  athyrea  (absence  of  secre- 
tion), are  associated  with  slow  and  stunted  growth,  retarded 
pulse,  phlegmatic  temperament,  juvenile  obesity,  delayed 
puberty  and  cretinism. 

In  girls,  delayed  menstruation,  amenorrhea,  chlorosis, 
hysteria  and  epilepsy  contribute  to  the  symptomatology. 

In  the  adult  one  finds  myxedema  and  an  abnormal 
tendency  to  obesity. 

Many  symptoms  of  senility  have  been  attributed  to 
hyposecretion,  notably  lesions  of  the  skin  (nutritive  distur- 
bances and  eczema). 

483 


Spondyloth     e    r    a    p    y 

In  certain  forms  of  melancholia  or  hysteria,  associated 
with  depression  and  tardy  cerebration,  thyroid  has  been 
phenomenally  efficient.  Peabody,86  avers  that  75  per  cent, 
of  patients  who  die  from  mental  disease  show  anomalous 
thyroid  glands. 

Vomiting  of  pregnancy  is  often  arrested  by  thyroid  ad- 
ministration, and  many  competent  observers  regard  thyroid 
as  an  excellent  treatment  for  eclampsia. 

Epileptic  attacks  associated  with  the  menstrual  period 
have  been  cured  by  thyroid.  Enlargement  of  the  thyroid 
gland  may  be  associated  either  with  a  diminished  or  excessive 
thyroid  secretion.  The  enlargement  may  be  structural 
(hyperplastic),  or  vascular.  Vascular  enlargement  (peculiar 
to  exophthalmic  goitre),  may  be  distinguished  from  hyper- 
plasia  (goitre),  by  the  fact  that  a  murmur  or  thrill  is  elicited 
when  the  gland  is  pressed  upon. 

HYPERTHYROIDISM. — In  hyperthyrea,  vagus-tone  is 
diminished  and  this  hypotonia  is  recognized  by  the  tests  on 
page  471,  et  seq. 

Little  can  be  expected  of  the  diagnostic-therapeutic  test 
for  the  reason  that  the  various  antithyroid  preparations  are 
inconstant  in  action  and  they  are  equally  lauded  by  some 
and  condemned  by  others. 

Symptoms  of  hyperthyrea  are  accentuated  by  certain 
preparations  described  on  page  453. 

A  seance  of  concussion  or  sinusoidalization  of  the  7th 
cervical  spine  lasting  five  minutes  will  reduce  the  rapid 
pulse  of  a  thyroid  heart  from  10  to  30  beats  and  ameliorate 
many  other  symptoms.  This  test  is  generally  reliable. 
Conversely,  if  one  concusses  the  3d  and  4th  dorsal  spines, 
the  symptoms  of  hyperthyroidism  are  accentuated. 

The  typical  disease  which  represents  an  excessive  secre- 
tion of  the  thyroid  gland  is  exophthalmic  goitre  (page  280). 

484 


Hype     r    t    h    y     r    o     i    d    i    s    m 

This  disease  occurs  more  frequently  in  women  than  in 
men. 

Transitory  hyperemia  of  the  gland  occurs  in  females  at 
puberty,  menstruation  and  pregnancy.  It  is  not  unlikely  that 
many  symptoms  at  these  periods  are  caused  by  hyperthy- 
roidism.  The  vascularity  of  the  thyroid  gland  is  enormous. 
Every  minute,  the  quantity  of  blood  passing  through  the 
gland  is  equivalent  to  six  times  its  weight  and  it  is  said  that 
it  is  twenty-eight  times  as  vascular  as  the  head,  and  five  and 
one-half  times  as  vascular  as  the  kidney. 

The  symptomatology  of  exophthalmic  goitre  is  made  up 
of  the  classic  tetrad:  struma,  tachycardia,  tremor  and  exoph- 
thalmos. 

The  recognizability  of  such  symptoms  is  facile.  It  is  the 
recognition  of  minimal  hyperthyroidism,  which  demands 
diagnostic  acumen.  Let  us,  however,  first  interpolate  cer- 
tain facts  concerning  the  thyroid  heart. 

Cardiac  disturbances  may  be  associated  with  all  forms 
of  goitre  and  conduce  to  the  condition  known  as  thyroid 
heart  (Kropfherz).  Goitre,  however,  may  be  secondary  to 
cardiac  disease  (cardiac  goitre).  The  cardiac  disturbances 
of  a  goitre  may  be  due  to  essentially  mechanic  causes  (pres- 
sure on  the  trachea,  veins  and  sympathetic  ganglia).  When 
pressure  is  exerted  on  the  sympathetic,  tachycardia  and 
exophthalmos  (usually  unilateral)  ensue,  leading  to  a  clinical 
picture  known  as  pseudo-exophthalmic  goitre. 

Cardiac  disturbances  may  also  be  caused  either  by  a 
deficient  or  excessive  secretion  of  the  thyroid  gland.  In  the 
former  (cardiopathia  thyreoprivea),  the  dominant  symptom 
is  cardiac  weakness,  insomuch  as  vagus- tone  is  largely 
dependent  on  the  secretion  of  the  gland  which  is  deficient. 
Early  arteriosclerosis  is  another  condition  associated  with 
hypothyroidism. 

485 


Spondyloth     e    r    a    p    y 

Insanity  may  be  associated  with  a  disfunctionating 
thyroid  and  psychoses  concurrent  with  exophthalmic  goitre 
are  not  infrequent.  The  psychotic  symptoms  represent  one 
of  two  groups:  maniacal  agitation  or  a  depressive  type. 
Some  authorities  claim  that  chronic  paranoia,  dementia 
precox  and  even  general  paresis  may  be  associated  with 
exophthalmic  goitre. 

The  fact  must  be  emphasized  that  hyperthyroidism  may 
be  present  without  visible  or  palpable  enlargement  of  the 
thyroid  gland. 

The  active  principle  of  the  gland  is  iodothyreo globulin. 
Thyreoglobulin  is  manufactured  within  the  cells  and  acquires 
its  iodin  from  the  blood. 

In  hyperthyroidism,  when  an  excess  of  iodothyreoglobulin 
is  thrown  into  the  blood,  metabolism  is  augmented  (loss  of 
weight),  and  there  is  a  stimulation  of  the  peripheral  nerves. 

The  early  recognition  of  atypic  forms  of  hyperthyroidism 
(formes  frustes)  is  of  great  importance  in  determining  the 
etiology  of  many  obscure  affections  which  masquerade  under 
a  medley  of  names.  The  symptoms  peculiar  to  hyperthy- 
roidism are  accentuated  by  factors  which  augment  the  vas- 
cularity  of  the  gland  or  decrease  vagus-tone.  Such  factors 
are:  menstruation,  pregnancy,  emotional  disturbances  (which 
diminish  vagus-tone,  page  466),  sexual  excitement,  genital 
disturbances  (chiefly  uterine),  infectious  diseases  (notably, 
influenza),  coffee,  tea,  alcohol  and  certain  drugs  (iodids 
and  especially,  thyroid  extract). 

The  fact  that  the  thyroid  gland  is  more  active  in  women 
accounts  for  the  predominance  of  their  nervous  and  hysteri- 
cal symptoms  and  the  fact  that  exophthalmic  goitre  occurs 
more  frequently  in  women  than  in  men. 

MENORRHAGIA  in  young  girls  and  women  is  often  a 

486 


Hyp    e    r    t    h    y    r    o    i    d   i   s    m 

symptom  of  hyperthyroidism,  whereas  hypothyroidism  is 
associated  with  amenorrhea  and  chlorosis. 

Menorrhagia  due  to  hyperthyroidism  may  be  con- 
trolled by  tablets  of  mammary  extract  in  doses  of  about  4 
grains  taken  thrice  daily.  The  tablets  must  be  crushed 
by  the  teeth  before  swallowing. 

MENOPAUSE  SYMPTOMS  are  unquestionably  associated 
with  hyperthyroidism.  Among  other  early  symptoms  are, 

1.  Cardiac  signs;  palpitation  and  irregularity,  increased 
pulse-rate,   attacks  of  tachycardia  and   throbbing  of  the 
arteries.    Digitalis  has  little  or  no  action  on  the  cardiac  signs. 

2.  Psychic  signs:  mental  excitement,  restlessness  and 
insomnia.    The  exalted  states  ensuing  from  wine  or  coffee 
are  probably  caused  by  a  transient  hyperthyroidism. 

3.  Ocular  signs:  widening  of  the  palpebral  slit,  staring 
without  winking  for  a  considerable  time  and  inability  of  the 
lids  to  follow  the  eyeballs  when  vision  is  directed  at  the 
descending  finger  of  the  physician.     In  the  author's  exper- 
ience when  the  lid  does  follow  the  ringer,  it  drops  in  'oto 
and  not  gradually. 

The  author  has  noted  an  accentuation  of  the  latter  symp- 
tom (v.  Graefe's  sign)  when  the  ringer  of  the  physician  is 
directed  downward  in  an  oblique  direction.  He  has  further 
noted  a  slight  spasmodic  retraction  of  the  lids  when  vision 
is  directed  downward  in  an  oblique  direction.  When  the 
patient  first  looks  at  an  object,  there  is  usually  a  spasmodic 
contraction  of  the  upper-lid  (Kocher-Boston  sign). 

4.  Nutritional  sign:  Loss  in  weight  despite  good  appe- 
tite and  digestion. 

Among  other  early  signs  are :  Feeling  of  heat,  elevation 
of  temperature,  flushes,  perspiration  and  a  fine  tremor. 

The  tremor  is  best  observed  when  the   patient  is 
directed  to  spread  the  fingers.    In  hyperthyroidism,  not- 

487 


Spondyloth 


a    p    y 


ably  in  exophthalmic  goitre,  I  have  noted  a  tendency  of 
the  fingers  to  become  adducted  when  separated  and  this 
tendency  especially  implicates  the  middle  and  fourth 
finger. 

There  is  another  symptom  which  I  have  observed 
and  that  is  dyspnea  on  exertion.  This  symptom  may  be 
caused  by  a  dilated  aorta,  a  condition  which  is  frequently 
associated  with  exophthalmic  goitre  and  which  is  easily 
recognized  by  careful  percussion  (page  558).  Kocher 
directs  attention  to  tenderness  of  the  thyroid,  a  systolic 
blowing  over  the  thyroid  arteries,  and  a  characteristic 
blood  picture:  leucocytes  half  as  numerous  as  usual, 
neutrophiles  reduced  and  lymphocytes  twice  the  normal 
figure.  In  the  absence  of  this  constant  blood-picture, 
he  will  not  operate. 

The  symptoms  of  hypersecretion  and  hyposecretion  of 
the  thyroid  may  be  recapitulated  as  follows: 

SYMPTOMS  OF  HYPERTHYROIDISM  AND  HvpoxHYROiDiSM87. 


HYPERTHYROIDISM. 

History  of  fatigue  and  slow 
onset. 

More  common  in  adoles- 
cence than  in  middle  life 
and  in  women. 

Cutaneous  flushing;  tachy- 
cardia; manifest  overac- 
tion  of  heart;  pulsation  of 
cervical  vessels;  all  in- 
creased by  exertion;  blood 
pressure  120-130. 

Mental  instability  and  ex- 
citability rather  than  men- 
tal alertness;  tremor;  rest- 
lessness; quick,  jerky 
movements  of  extremi- 
ties; insomnia. 


HYPOTHYROIDISM. 

1.  The  same. 

2.  More  common  during  and 

after  middle  life  and  in 
women. 

3.  Flushed    skin    over    malar 

prominences  only,  marked 
pallor  elsewhere ;  slow 
pulse;  blood-pressure  us- 
ually below  1 20. 

4.  Mentality   sluggish,    rather 

than  dull;  headache;  in- 
somnia with  changes  to 
somnolence  only  in  ter- 
minal stages;  slow  move- 
ments. 


488 


Hyperthyroidism  and  Hypo  thy  roidism 


6. 


10. 
ii. 


12. 


Muscular  weakness  and  in- 
ability to  withstand  ordi- 
nary fatigue. 

Exophthalmos  generally 
present  in  some  degree, 
and  the  more  marked  it 
is  the  worse  is  the  prog- 
nosis. It  is  often  absent 
in  the  early  stages. 


Goiter  of  variable  size  and 
consistency.  Its  vascu- 
larity  and  density  give 
some  indication  of  the 
relative  importance  of  the 
thyroid  in  the  general 
disturbance;  goiter  is 
often  imperceptible  in  the 
early  stages. 

Appetite  abnormally  good 
and  out  of  proportion  to 
the  evident  poor  nutrition; 
movements  regular  or 
diarrheic.  Thirst  con- 
stant. 

Skin  moist  with  a  subjective 
feeling  of  heat. 

Temperature  99  to  101. 

Blood  shows  relative  lym- 
phocytosis,  anemia  slight 
or  absent. 

Menstruation  irregular  or 
absent. 

Urine  in  nitrogen  partition 
shows  excess  of  creatin 
and  diminished  creatinin. 


5.   The  same. 


6.  No  exophthalmos  except  in 

those  who  have  passed 
through  a  preceding 
Graves'  disease.  In  place 
of  it  there  is  a  charac- 
teristic puffiness  and 
edema  around  the  eyelids 
and  in  the  supraclavicular 
regions  and  on  the  back 
of  neck  and  below  the 
knees. 

7.  Goiter  is  common,  but  by  its 

consistency  and  absence 
of  vascularity  suggests  a 
functionless  organ. 


Appetite  poor;  apparently 
good  nutrition.  Consti- 
pation. No  thirst. 


9.   Skin  dry  and  scaly;  subjec- 
tive feeling  of  cold. 
10.   Temperature  subnormal. 
,11.   Negative,  anemia  regularly. 


12.  Regular  but  scanty,  occas- 

sionally  excessive. 

13.  Negative;    albumin    some- 

times present. 


489 


Spondyloth     e    r    a    p    y 

The  TREATMENT  of  exophthalmic  goitre  is  equally  appli- 
cable for  the  minor  and  atypic  manifestations  of  hyperthy- 
roidism. 

In  the  conventional  medical  treatment,  which  ranges 
from  Galvanization  of  the  cervical  sympathetic  and  exposure 
to  the  X-rays  to  the  use  of  specific  sera,  the  results  are  uncer- 
tain and  recurrence  is  the  rule. 

Respecting  operative  treatment  (thyroidectomy),  the  re- 
sults achieved  by  Kocher  (who  has  had  the  largest  experience 
in  such  cases),  are  as  follows:  absolute  and  permanent  cure 
in  83  per  cent.,  and  3.5  per  cent,  of  deaths.  C.  H.  Mayo 
had  9  deaths  in  176  cases. 

Removal  of  the  sympathetic  ganglia  (sympathectomy), 
on  both  sides  is  a  procedure  unattended  by  good  results. 

The  author's  method  of  treatment  (page  280)  is  practi- 
cally a  specific  in  hyperthyroidism  and  the  results  are  immed- 
iate and  usually  permanent.  Recurrence  of  symptoms 
is  transient  and  associated  with  factors  which  augment  the 
vascularity  of  the  thyroid  gland.  The  first  symptoms  to 
yield  are  tachycardia  and  cardiac  irregularities,  nervousness 
and  perspiration.  Exophthalmos  is  the  most  resistant  sign 
and  may  yield  synchronously  with  the  other  signs,  it  may 
improve  after  treatment  is  suspended  or  it  may  be  permanent. 

Operations  yield  no  better  results,  for  in  cases  of  long 
standing  the  exophthalmos  is  permanent  owing  to  the  deposit 
of  orbital  fat  which  causes  the  eye  to  protrude  even  though 
the  muscle  of  Miiller  is  no  longer  contracted. 

The  exophthalmos  and  separation  of  the  lids  in  Exo- 
phthalmic goitre  is  caused  by  contraction  of  Miiller's 
muscle  which  is  innervated  by  the  cervical  sympathetic. 
This  muscle  is  attached  to  the  bony  wall  of  the  orbit  and 
is  inserted  into  the  sclerotic  coat  of  the  eyeball  and  the 
upper  or  lower  lids. 

490 


Exophthalmic     Goitre 

Reports  received  from  many  physicians,  respecting 
the  author's  treatment  of  exophthalmic  goitre  are  very 
encouraging.  In  several  instances,  only  the  methods  of 
concussion  shown  in  Figs.  2  and  3  were  used. 

One  physician  writes,  "in  one  week  tachycardia 
reduced  from  160  to  no,  enlargement  of  thyroid  gland 
decreased  about  one-half,  although  exophthalmos  is  the 
same." 

Another  reports,  "I  have  never  witnessed  such  rapid 
and  marvelous  results  in  the  treatment  of  a  disease." 

Another  says,  "Within  three  weeks  practically  every 
symptom  disappeared  but  at  the  next  menstrual  period 
some  symptoms  recurred  but  have  not  reappeared  up  to 
the  present  time  of  writing." 

A  physician,  whose  enthusiasm  regarding  the  author's 
method  was  dictated  by  results,  observes  as  follows: 
"It  is  only  a  question  of  time  when  physicians  will  and 
must  recognize  your  specific  treatment  and  when  it  will 
be  regarded  as  criminal  negligence  for  the  physician  to 
invoke  surgery  before  giving  your  method  a  trial." 

A  physician  reported,  "The  symptoms  were  aggra- 
vated." On  inquiry,  I  found  that  he  was  concussing  not 
only  the  ;th  cervical  spine,  but  likewise  the  upper  dorsal 
spines  (which  decreased  vagus-tone).  I  have  never 
heard  further  concerning  his  results.  Any  of  the  methods 
for  increasing  vagus-tone  as  suggested  on  page  469,  are 
available  in  treatment. 

Dr.  M.  Turnbull  cites  one  case  with  a  history  of 
exophthalmic  goitre  for  1 5  years.  Despite  an  operation 
(ligation  of  thyroid  arteries),  the  enlarged  gland  and  car- 
diac signs  persisted.  Within  2  weeks,  no  gland  could  be 
seen  nor  palpated  and  the  cardiac  signs,  tremor,  etc, 
disappeared.  At  one  menstrual  period,  the  gland  en- 
larged for  2  days. 

In  this  patient,  a  woman  of  28,  the  hair  had  become 
thin  and  absolutely  white.  Soon  after  the  commencement 
of  treatment,  the  hair  grew  more  luxuriantly  and  is  being 
restored  to  its  natural  color  (brown). 

491 


Spondyloth    e    r    a    p    y 

In  another  patient,  all  the  symptoms  subsided  in 
three  weeks  excepting  the  exophthalmos  which  was 
ameliorated  about  50  per  cent.  The  patient  gained  one- 
half  pound  a  day  for  about  three  weeks.  In  both  cases, 
the  treatment  was  concussion  of  the  7th  cervical  spine. 

In  some  of  the  author's  cases,  patients  who  were 
apparently  obese  lost  considerably  in  weight.  This  was 
probably  due  to  edema  and  myxedema  complicating 
exophthalmic  goitre  and  coincident  with  improvement 
of  the  latter,  myxedema  and  edema  disappeared. 

Among  letters  received  from  physicians,  one  question  is 
paramount:  "Will  concussion  cure  simple  forms  of  goitre?" 
The  reply  to  this  question  may  be  as  follows:  The  greater 
the  vascularity  of  the  gland  (soft  and  tender, systolic  blowing), 
the  greater  is  the  chance  for  its  reduction.  When  much 
fibrous  tissue  has  developed  no  results  can  be  expected. 

Treatment  by  concussion  is  so  simple  that  it  should  at 
least  be  given  a  trial. 

Very  often  a  goitre  is  a  true  hypertrophy  occurring  in 
response  for  an  augmented  supply  of  secretion.  Here,  the 
use  of  thyroid  extract  will  cause  a  reduction  in  the  size  of  the 
gland. 

EMACIATION. — In  some  individuals  despite  careful  exam- 
ination, one  cannot  account  for  their  poor  nutrition.  Weir 
Mitchell,  and  later,  Playfair,  demonstrated  the  great  value  of 
forced  alimentation  in  many  neuroses.  This  mastcure  or 
methodical  overfeeding  was  used  in  combination  with  an 
absolute  rest  cure.  As  I  take  a  retrospect  of  the  cases  thus 
treated  and  of  my  success  and  failures,  I  now  believe  that 
I  was  unconsciously  treating  thyroid  glands  in  a  condition 
of  hypersecretion.  In  a  rest  cure  one  executes  all  the  methods 
necessary  to  depress  the  functions  of  the  gland,  viz.:  rest, 
seclusion,  quiet,  an  absence  of  genital  irritation  and  sexual 

492 


Exophthalmic     Goitre 


Fig.  117. — Case  of  Exophthalmic  goitre  made  up  of  the  following  tetrad: 
tachycardia,  exophthalmos,  tremor  and  pulsating  thyroid  gland.  i.: — Sphygmo- 
gram  of  pulsating  struma  before  commencing  treatment  (the  record  shows  tachy- 
cardia and  irregularity  of  pulsations) ;  2. — Tracing  of  gland  after  5  minutes  appli- 
cation of  the  rapid  sinusoidal  current  in  the  region  of  the  yth  cervical  spine.  3. — 
Tracing  of  tremor  before  treatment;  4. — Tracing  of  tremor  after  sinusoidalizalion 
in  the  region  of  the  yth  cervical  spine;  5  and  6. — Cardiogram  and  pneumogram 
before,  and  7  and  8,  the  same  after  concussion  of  the  yth  cervical  spine.  Respiratory 
ataxia  (page  85)  is  a  not  infrequent  sign  (according  to  the  observations  of  the 
author)  in  this  disease.  This  patient's  heart  became  absolutely  normal  in  rhythm 
after  3  treatments  of  concussion  to  the  seventh  cervical  spine  although  this  irre- 
gularity had  existed  since  the  inception  of  her  disease  15  years  before. 


493 


S  p    o    n    d    y    I    o    t    h     e    r    a    p    y 

excitement  and  a  diet  of  milk  and  farinaceous  foods  with  a 
minimum  of  meat. 

Many  of  my  cases  in  women  suffered  from  relapses  and 
not  infrequently  three  rest  cures  were  given  in  a  single  year. 
Some  of  these  cases  showing  reduced  vagus-tonus,  have 
since  then  been  treated  successfully  by  concussion  of  the  yth 
cervical  spine  or  by  para  vertebral  pressure.  Improvement 
is  associated  with  an  increase  in  weight  without  any  change 
in  the  diet.  Treatment  at  my  office  was  supplemented  by 
contraction  of  the  cervical  muscles  (page  2  2  8)  or  by  para  ver- 
tebral pressure  corresponding  to  the  yth  cervical  spine  (page 
467),  three  or  four  times  a  day  for  one  minute  each  time. 

BRONCHIAL  ASTHMA. — Reference  has  already  been  made 
to  this  subject  on  page  303,  with  supplementary  observations 
on  page  456.  This  disease  is  practically  always  associated 
with  vagus-hypertonia.  Even  in  the  norm,  if  an  assistant 
maintains  firm  pressure  at  the  yth  cervical  spine  with  the 
instrument  shown  in  Fig.  112,  within  thirty  seconds  to  two 
minutes,  one  can  auscultate  rdles  peculiar  to  asthma  In 
asthmatics  or  in  cases  of  vagus-hypertonia,  less  pressure  or  a 
shorter  interval  of  time  is  necessary  to  create  rales. 

Asthmatic  paroxysms  may  be  arrested  by  firm  pressure 
with  the  thumbs  in  the  absence  of  an  instrument  on  both 
sides  of  the  column  between  the  third  and  fourth  dorsal 
spines. 

The  foregoing  facts  are  of  great  importance  in  pulmonary 
auscultation.  Many  adventitious  sounds  are  due  either  to 
increased  or  diminished  vagus-tonus  and  by  availing  our- 
selves of  the  maneuvers  suggested,  one  may  avoid  errors  in 
diagnosis. 

Boeri88,  found  that  when  no  abnormal  breath-sounds 
were  heard  over  the  apex  in  incipient  phthisis,  they  became 
audible  after  a  few  minutes  deep  massage  over  the  apex  of 

494 


Bronchial       A    s    t   h 


m    a 


the  lung.  The  phenomenon  in  question  is  probably  due  to 
an  augmentation  of  tone  of  the  vagus  ensuing  from  massage. 
Stretching  the  neck  (Fig.  65)  several  times  in  succession 
accomplishes  the  same  object. 

Phthisis  is  a  disease  usually  due  to  hypertonia,  and  one 
frequently  finds  it  associated  with  bronchospasm,  a  condition 
not  unlike  asthma.  If  one  makes  pressure  for  about  one 
minute  between  the  third  and  fourth  dorsal  spines,  the  rdles 
peculiar  to  asthma  or  bronchospasm  disappear. 

Respecting  the  treatment  of  asthma,  my  experience  con- 
cerns itself  chiefly  with  the  method  described  on  page  312. 
My  more  recent  experience  justifies  me  in  saying  that  I  be- 
lieve more  expeditious  results  may  be  achieved  by  depressing 
vagus-tone  and  to  attain  this  object  it  is  suggested  to  employ 
sinusoidalization  or  concussion  of  the  region  for  depressing 
the  vagus  and  to  supplement  it  by  treatment  at  home,  viz. : 
pressure  three  or  four  times  a  day  for  one  minute  at  a  point 
on  either  side  of  the  column  between  the  third  and  fourth 
dorsal  spines. 

In  my  experience,  paroxysmal  dilatation  of  the  thoracic 
aorta  may  simulate  asthma.  Here  one  finds  by  careful 
percussion  an  increase  in  the  area  of  aortic  dulness.  Vagus- 
tone  is  diminished  and  not  increased  as  in  asthma.  In  such 
instances  of  pseudo-asthma,  the  treatment  indicated  is  that 
for  aneurysms. 

EMPHYSEMA. — Increased  vagus-tonus  is  associated  with 
this  condition  in  a  number  of  instances,  notably  in  young 
persons.  We  have  already  noted  (page  296)  how  one  may 
transitorily  dissipate  the  disease  by  nasal  cocainization. 
The  methods  employed  for  reducing  vagus-tone  should  be 
given  a  trial.  One  must,  however,  carefully  supervise  the 
treatment  to  avoid  the  development  of  symptoms  dependent 
on  reduced  vagus-tonus. 

495 


Spondyloth     e    r    a    p    y 

In  some  instances,  diminished  vagus-tone  being  present, 
the  antithetic  method  of  treatment  is  indicated. 

CARDIAC  NEUROSES. — The  pharmacologic  diagnosis  of 
these  affections  has  been  discussed  on  page  454.  They  may  be 
associated  with  increased  or  diminished  vagus-tonus. 

GASTRIC  NEUROSES. — The  vagus  controls  the  tone, 
peristalsis  and  secretion  of  the  stomach.  When  the  tone  of 
the  nerve  is  pathologically  increased  the  motor,  sensory  and 
secretory  phenomena  of  the  organ  are  accentuated  and  give 
expression  to  clinical  pictures  identified  with  the  gastric 
neuroses. 

Esophagismus,  may  be  attributed  to  the  same  cause  and 
one  may  note  its  temporary  evanescence  by  methods  which 
reduce  vagus- tone,  viz. :  paravertebral  pressure  or  an  hypo- 
dermatic injection  of  atropin. 

INTESTINAL  NEUROSES. — In  the  diagnosis  of  these  affec- 
tions one  must  remember  that  atropin  inhibits  and  that 
pilocarpin,  intensifies  intestinal  peristalsis.  The  many 
affections  identified  with  increased  or  diminished  vagus-tone 
include  diarrhea,  constipation  and  membranous  enteritis. 
The  latter  is  probably  a  motor-secretory  neurosis  and  is 
favorably  influenced  by  atropin.  In  individuals  with  this 
disease,  the  use  of  pilocarpin  may  precipitate  a  paroxysm. 

DISTURBANCES  OF  VISION.* — Vagus-tone  is  identified 
with  hysterical  and  neurasthenic  forms  of  amblyopia  and 
asthenopia. 

The  former  refers  to  reduced  visual  acuity,  contraction 
of  the  field  of  vision  and  the  field  for  colors. 

The  diagnosis  of  hysterical  amblyopia  is  established  by 
the  absence  of  demonstrable  ocular  changes,  exhaustion  of 
the  visual  field  during  examination  and  by  the  fact  that  the 

*A  preliminary  reading  of  the  subject-matter  on  page  441,  will  aid  in  the  better 
understanding  of  this  caption. 

496 


As       then       op        i       a 

contraction  of  the  field  for  colors  is  reversed  (limits  for  red 
wider  than  those  for  blue.) 

The  oculist  observes  that  the  acuity  of  vision  and  the 
extent  of  the  visual  field  varies  with  the  amelioration  or 
aggravation  of  the  health  of  the  patient. 

That  this  form  of  amblyopia  is  a  matter  of  vagus-tone 
I  have  demonstrated  as  follows:  In  a  normal  subject, 
determine  with  a  perimeter  the  extent  of  the  normal  field  of 
vision  and  the  field  for  colors.  Then,  during  the  time  the 
vagus-tone  is  depressed  by  an  assistant  (pressure  between  the 
third  and  fourth  dorsal  spines),  again  determine  the  fields. 
One  notes  that  the  visual  field  is  contracted  and  the  field  for 
colors  reversed.  Pressure  at  the  yth  cervical  spine  will  in- 
crease the  extent  of  both  fields. 

In  asthenopia,  despite  good  visual  power,  the  eye  becomes 
incapacitated  for  continuous  exertion  and  the  patient  com- 
plains of  pains  in  or  above  the  eyes,  frontal  or  occipital 
headaches,  neuralgia,  lacrymation  and  burning  sensation  in 
the  lids,  blurring  of  near  vision  and  a  host  of  other  symptoms. 

The  foregoing  signs  are  always  accentuated  with  arti- 
ficial illumination,  after  reading,  writing,  sewing  and  other 
forms  of  near  application  and  in  disturbances  of  the  general 
health.  Even  in  the  norm,  one  may  provoke  asthenopic 
symptoms  by  reducing  vagus-tone  (pressure  between  the 
third  and  fourth  dorsal  spines),  during  the  time  patient  is 
requested  to  read.  Each  eye  may  be  separately  tested. 
Pressure  at  the  seventh  cervical  spine  will  improve  acuity  of 
vision  and  in  asthenopia,  vision  previously  blurred,  becomes 
sharp  and  defined. 

The  maneuvers  suggested  do  not  modify  the  vision  of  an 
astigmatic,  myopic  or  hypermetropic  eye. 

We  have  already  demonstrated  (page  443),  that  eye-strain 
is  equivalent  to  vagus-stimulation  and  will  evoke  the  vagal- 

497 


Spondylotherapy 

reflexes.  If,  however,  one  cocainizes  the  eyes  with  a  5  per 
cent,  solution  in  a  normal  subject,  the  vagal  reflexes  cannot 
be  obtained.  Paradoxical  as  it  may  appear,  the  reflexes 
continue  despite  the  use  of  homatropin  or  atropin. 

The  foregoing  facts  are  in  defiance  of  current  opinion 
insomuch  as  atropin  as  a  cycloplegic,  by  paralyzing  accom- 
modation, is  supposed  to  annihilate  the  majority  of  ocular 
reflexes.  I  have,  however,  made  repeated  tests  in  this  respect 
and  the  results  have  been  practically  uniform. 

The  preceding  facts  furnish  an  important  guide  in  treat- 
ment. Many  patients  with  amblyopia  and  asthenopia  suffer 
for  years  and  are  incapacitated  for  serious  occupation. 
Glasses  often  give  no  relief  and  stimulation  by  strychnin 
and  electricity  are  the  usual  remedies. 

Concussion  or  sinusoidalization  of  the  seventh  cervical 
spine  to  increase  vagus-tone,  and  supplementing  this  method 
by  home-treatment  (paravertebral  pressure  or  extension  of 
the  muscles  of  the  neck),  may  rescue  some  patients  from 
hopeless  invalidism. 

In  rarer  instances,  spasm  of  accommodation  (asthenopic 
symptoms  and  diminished  acuteness  of  vision),  may  necessi- 
tate depression  of  vagus-tone  (pressure  between  the  third 
and  fourth  dorsal  vertebrae  or  concussion  of  the  latter). 

Dr.  B.  L.  Baker,  of  Seattle,  referring  to  a  patient  with 
intractable  symptoms  in  whom  sinusoidalization  (elec- 
trodes on  either  side  of  the  yth  cervical  spine)  was  em- 
ployed, observes  as  follows:  "Abnormal  sensations  of 
long  standing  were  removed  and  she  was  able  to  be  fitted 
with  glasses  in  a  very  satisfactory  way.  Perfectly  so  in 
her  left  eye  which  we  were  never  able  to  do.  The  eyes 
when  turned  in  any  direction  caused  intense  pain  and 
nausea  but  the  latter  symptoms  have  disappeared." 

DISTURBANCES  or  HEARING. — I  believe  that  the  sense  of 

498 


Auditory      N    e     r     v     e 

audition  is  under  the  control  of  the  autonomic  nervous 
system. 

The  following  simple  experiment  will  show  how  audition 
may  be  improved  or  diminished;  determine  with  a  normal 
subject  the  distance  at  which  the  tick  of  a  watch  is  heard  in 
the  ear  under  examination.  If  an  assistant  now  presses  the 
seventh  cervical  spine  with  an  instrument  (Fig.  112)  to  in- 
crease vagus- tone,  the  patient  perceives  the  tick  at  a  greater 
distance.  If  pressure  is  now  made  between  the  third  and 
fourth  dorsal  spines,  to  diminish  vagus-tone,  the  tick  is  heard 
with  less  intensity  and  at  a  diminished  distance.  Hearing  in 
the  norm  may  be  made  more  acute  after  concussion  of  the 
seventh  cervical  spine  or  after  exercises  which  embrace 
extension  of  the  head  (page  228).  More  accurate  quantitative 
tests  may  be  made  with  Politzer's  acoumeter. 

The  auditory  nerve  consists  of  the  cochlear  and  vesti- 
bular  roots.  The  former  is  concerned  in  hearing  and  the 
latter  in  the  maintenance  of  equilibrium.  Hyperesthesia 
and  irritation  of  the  nerve  may  be  manifested  by  hyper- 
acusis  (sounds  heard  with  disagreeable  intensity), 
dysacusis  (sounds  cause  unpleasant  sensations),  or  as 
tinnitus  aurium  (subjective  sounds).  Another  symptom 
of  irritation  may  be  dizziness  somewhat  like  Meniere's 
disease.  Diminished  function  or  nervous  deafness  is  not 
infrequent  in  hysteria  and  bone  c-onduction  is  impaired 
or  lost. 

Neurasthenia  and  hysteria  are  the  most  frequent 
functional  nervous  affections  which  exert  the  most  pro- 
nounced effect  upon  the  organ  of  hearing.  With  the 
tests  cited,  one  may  facilitate  diagnosis.  The  specialist 
does  not  hope  to  modify  these  functional  symptoms 
without  treating  the  conditions  which  cause  them. 
However,  one  must  not  forget  that  they  may  be  signs  of  a 
local  vagus-hypotonia or  hypertonia,  (page 452),  and  may 
be  modified  or  cured  by  treating  the  irritative  (reducing 

499 


Spondyloth     e    r    a    p    y 

vagus-tone)  or  paralytic  symptoms  (increasing  vagus- 
tone)  . 

The  sense  of  smell  may  also  be  modified  according  to 
the  methods  cited  for  increasing  or  decreasing  the  sense 
of  hearing. 

One  may  continue  to  dangerous  extremes  in  the  dis- 
cussion of  this  subject.  The  author  has  limited  himself 
to  a  consideration  of  questions  which  he  has  amply  veri- 
fied by  clinical  results  and  he  has  attempted  to  show  the 
necessity  for  testing  vagus-tone  as  a  routine  measure  in 
clinical  practice  with  the  hope  that  it  may  lead  to  a  bet- 
terment of  our  nosology.  In  diagnosis,  diminished  or  in- 
creased vagus-tone  may  modify  symptoms,  and  I  shall 
show  how  one  may  create  at  will  certain  cardiac  mur- 
murs and  how  they  may  be  made  to  disappear  (page  525). 
The  creation  of  adventitious  respiratory  sounds  has  been 
already  discussed  (page  494). 

PHYLOGENETIC  DISEASES. 

The  term  phylogenesis,  refers  to  the  evolution  of  a  group 
or  species  of  animals  or  plants  from  the  simplest  form.  For 
a  like  reason,  I  employ  this  designation  in  accordance  with 
my  concept  that  many  diseases  and  symptoms  owe  their 
origin  to  a  primal  basic  anomaly.  The  preceding  contra- 
venes the  ontogenic  conception  of  disease. 

Among  the  diseases  in  which  I  have  established  reduced 
vagus-tone  are  the  following: 

1.  AORTIC  DILATATION. 

2.  ANEURYSM. 

3.  DIABETES. 

4.  HYPERTHYROIDISM. 

5.  PERTUSSIS. 

A  dilated  aorta  is  probably  one  of  the  causes  of  dyspnea 
in  exophthalmic  goitre  (page  488).  In  four  of  my  cases, 

500 


Phylogenetic      Diseases 

classic  symptoms  of  aneurysm  (thoracic)  were  associated 
with  Basedow's  disease. 

Glycosuria  was  found  in  several  patients  with  aneurysm. 

A  patient  with  an  aneurysm  of  the  thoracic  aorta, 
referred  to  me  by  Dr.  Hubert  N.  Rowell,  of  Berkeley  and 
who  was  discharged  as  symptomatically  cured  after 
treatment  lasting  four  weeks,  returned  after  three  years 
absolutely  well  respecting  the  aneurysm  but  with  sym- 
toms  of  diabetes  (3  per  cent,  of  sugar  despite  the  most 
rigid  diet).  Vagus-tone  absent.  Within  three  weeks 
after  treatment  (concussion  of  seventh  cervical  spine), 
the  lower  lung-border  which  did  not  descend  at  all  when 
pressure  was  made  at  the  7th  cervical  spine-region,  de- 
scended 3  cm.,  and  sugar  disappeared  from  the  urine, 
notwithstanding  the  ingestion  of  the  average  carbo- 
hydrate consumption.  At  the  time  of  writing,  the  patient 
is  well.  Before  coming  to  my  office  the  second  time,  the 
attention  of  the  patient  was  called  to  his  condition  by 
polyuria  and  an  intractable  neuritis.  The  latter  disap- 
peared with  disappearance  of  sugar  in  the  urine. 

It  is  easy  to  explain  many  anomalies  of  function  by 
correctly  assuming  modifications  in  glandular  activity. 
Thus,  the  amount  of  epinephrin  produced  and  entering 
the  circulation  varies.  This  substance  stimulates  plain 
muscle  and  glandular  cells  which  are  functionally  related 
to  the  sympathetic  nerve-fibers.  Its  subcutaneous  ad- 
ministration causes  the  appearance  of  dextrose  in  the 
urine  and  a  condition  of  hyperglycemia. 

Exophthalmic  goitre  is  coordinated  with  emaciation  and 
occasionally,  with  polyuria,  glycosuria  and  true  diabetes. 

Pertussis  is  associated  with  aortic  dilatation  (Chapter  XVII) 
and  in  both  affections  the  vagus- tonus  is  reduced.  Some 
infectious  diseases  reduce  vagus-tone  and  they  may  be  recog- 
nized as  etiologic  factors  in  Basedow's  disease  and  aneurysm 
(syphilis). 

501 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

A  neurotic  temperament  (reduced  vagus-tone)  is  a  domi- 
nant etiologic  factor  in  diabetes.  One  notes  the  occurrence 
of  the  same  or  like  diseases  in  one  family  or  between  man 
and  wife,  maladies  which  I  have  called  diseases  of  prop- 
inquity. Contagious  influences  like  tuberculosis  are  not  in- 
cluded in  this  category.  Thus,  Schmidt  observed  among 
2320  diabetics,  twenty-six  cases  in  which  the  disease  occurred 
concurrently  in  man  and  wife. 

It  is  questionable  concerning  the  role  played  by  food  in 
the  etiology  of  reduced  vagus-tone,  although  my  limited 
observations  show  that  an  exclusive  diet  of  proteid  food  has 
a  marked  influence  in  reducing  vagus-tone. 

I  recently  saw  two  sisters  in  consultation  with  Dr.  L. 
Boyd,  of  Long  Beach,  one  of  whom  had  diabetes,  and  the 
other  an  aneurysm  of  the  thoracic  aorta. 

Among  the  diseases  in  which  there  is  increased  vagus- 
tone  are: 

1 .  BRONCHIAL  ASTHMA. 

2.  EMPHYSEMA. 

3.  TUBERCULOSIS. 

4.  GASTRIC  and   INTESTINAL  NEUROSES. 

Emphysema  is  almost  invariably  associated  with  phthisis 
and  asthma.  In  my  clientele,  I  have  frequently  noted  pul- 
monary tuberculosis  following  asthma  and  observed  that  the 
cough  and.  paroxysmal  dyspnea  of  the  latter  affection  were 
often  caused  by  bronchos pasm.  Asthma  often  runs  in 
families  with  irritable  nervous  systems  and  the  reflex  causes 
which  provoke  attacks  also  augment  vagus-tonus. 

Many  gastric  and  intestinal  neuroses  are  associated  with 
symptoms  of  cardiac  disease  suggestive  of  vagus-hypertonia. 

Enuresis,  was  frequently  observed  by  the  author  in 
asthmatic  children  and  reduction  in  the  tone  of  the  vagus 

502 


Reflex       Symptoms 

was  productive  of  good  results.  The  mother  was  in- 
instructed  to  make  pressure  several  times  a  day  on  either 
side  of  the  spine  between  the  3d  and  4th  dorsal  vertebrae 
to  reduce  vagus-tone. 

Dr.  L.  Boyd  reports  the  case  of  a  young  man  of  20 
years,  with  enuresis  since  birth.  Treatment  had  been 
tried  without  results.  Concussion  of  the  fifth  lumbar 
vertebra  to  provoke  the  bladder  reflex  (page  358)  yielded 
excellent  results. 

A  placebo  was  given  to  the  patient.  The  author  finds 
it  absolutely  necessary  with  some  patients  to  employ  an 
indifferent  drug  in  association  with  treatment.  Some 
patients  are  obsessed  with  the  conviction  that  drugs  are 
the /ons  et  origo  of  medical  practice  and  they  will  con- 
tinue no  treatment  in  which  drugs  are  excluded. 

"It  is  quite  as  important  to  know  what  kind  of  a 
patient  the  disease  has  got,  as  to  know  what  kind  of  a 
disease  the  patient  has  got." 

"The  patient  wishes  not  only  to  be  cured,  but  to  be 
treated;  his  luxury  is  the  importance  of  the  physician 
and  his  remedies." 

Reflex  symptoms  may  so  mask  the  primary  disease  that 
the  latter  is  disregarded.  Reduced  tone  of  the  vagus  is 
associated  with  dilatation  of  the  heart  and  the  symptoms  may 
be  essentially  abdominal  owing  to  the  rapid  distension  of  the 
liver  and  the  paralytic  inflation  of  the  stomach  and  intestines. 

The  attacks  in  some  forms  of  angina  pectoris  and 
certain  neuroses  terminate  with  eructations  of  gas  and 
the  discharge  of  a  large  quantity  of  clear  urine. 

What  probably  occurs  is  as  follows:  The  increased 
vagus-tonus  closes  the  cardiac  or  pyloric  orifice  of  the 
stomach  and  when  the  tone  of  the  vagus  is  reduced,  the 
orificial  spasm  of  the  stomach  yields,  permiting  eructa- 
tion of  the  incarcerated  gas. 

I  have  seen  two  cases  of  aneurysm  of  the  abdominal 
aorta  in  which  there  were  only  thoracic  symptoms. 

503 


Spondyloth     e    r    a    p    y 

The  crises  of  tabes  are  caused  by  autonomic  irritation 
as  evidenced  by  pupillary  contraction,  increased  secre- 
tion and  peristalsis  of  the  stomach  and  intestines.  In 
the  later  stages  of  the  disease,  the  hypertonic  are  suc- 
ceeded by  hypotonic  signs.  One  knows  that  in  tabes, 
anatomic  lesions  of  the  vagus  may  be  demonstrated. 

VAGAL  HYPERESTHESIA. — In  diseases  caused  by  vagus- 
hypertonia,  the  vagus  in  the  neck  is  extremely  sensative  to 
pressure,  whereas  in  diseases  caused*  by  vagus-hypotonia, 
paravertebral  areas  of  tenderness  may  be  detected  between 
the  third  and  fourth  dorsal  spines. 

The  sensitiveness  in  question  disappears  pari  passu  with 
the  disappearance  of  the  disease.  The  dorsal  areas  become 
less  sensitive  at  once  by  concussion  of  the  yth  cervical  spine 
(which  increases  vagus-tone)  and  the  vagus  in  the  neck,  by 
concussion  of  the  third  and  fourth  dorsal  spines  (which  de- 
creases vagus- tone). 

CLINICAL  PHARMACOLOGY. 

The  scientific  study  of  pharmacology  should  not  be 
limited  to  laboratory-animals,  on  the  contrary,  the  human 
offers  a  fruitful  field  for  investigation  (vide,  page  270).  The 
author  has  investigated  many  drugs  and  concludes  that  a 
large  number  owe  their  physiologic  and  toxic  action  to  their 
influence  on  vagus-tone.  Only  a  few  drugs  will  be  cited, 
insomuch  as  the  scope  of  this  work  precludes  any  extended 
reference  to  this  subject.  The  author  suggests,  however, 
that  it  may  serve  as  an  index  for  research  work  along  new 
and  original  lines. 

Many  drugs,  according  to  their  action,  may  be  divided 
into  two  classes: 

1.  Drugs  which  increase  vagus-tone; 

2.  Drugs  which  diminish  vagus-tone. 

504 


Clinical    Pharmacology 

Their  action  may  be  manifested  directly  or  indirectly. 
Thus  adrenalin  acting  exclusively  on  the  sympathetic-fibers 
by  stimulation,  depresses  the  vagus-fibers  and  therefore  indi- 
rectly diminishes  vagus-tone  (page  453). 

METHOD  OF  INVESTIGATION. — As  we  have  already  shown 
(page  469),  para  vertebral  pressure  at  the  yth  cervical  spine 
increases  vagus-tone  and  among  other  effects  it  causes  the 
lower-lung  border  to  descend.  The  degree  and  duration  of 
descent  are  accepted  as  criteria  of  vagus- tone.  The  lower 
lung-border  posteriorly  is  first  determined,  after  which 
pressure  is  made  opposite  the  yth  cervical  spine  for  30  seconds 
and  the  lower  border  is  again  ascertained.  Not  only  must 
we  determine  the  degree  of  descent  but  its  duration. 

Drugs  which  act  by  increasing  vagus-tone  cause  a  descent 
of  from  4  to  6  cm.,  and  this  descent  is  maintained  from  one 
to  ten  or  more  minutes.  Drugs  which  diminish  vagus-tone 
cause  little  or  no  descent  of  the  lung  and  if  the  latter  does 
descend,  its  descent  is  brief.  Many  drugs  show  a  primary 
stimulation  of  vagus-tone  followed  by  depression  of  the  latter. 
Powerful  vago-tonic  drugs  cause  a  descent  of  the  lung-border 
without  previous  pressure  at  the  yth  cervical  spine. 

Reference -has  been  made  to  some  drugs  investigated  by 
the  author.  Among  other  drugs  may  be  mentioned: 

QUININ. — This  drug  has  a  powerful  action  in  increasing 
the  tone  of  the  vagus. 

It  is  now  possible  to  comprehend  many  therapeutic  facts 
heretofore  inexplicable. 

Exophthalmic  goitre  is  due  to  diminished  vagus-tone 
(page  484).  Now,  among  the  most  satisfactory  drugs  for 
influencing  the  latter  disease  is  quinin  hydrobromid  in 
capsules  containing  5  grains  each,  to  the  limit  of  the 
patient's  tolerance.  Toxicity  is  shown  by  the  appearance 
of  tinnitus,  when  the  use  of  the  drug  must  be  suspended 

505 


S  p    o    n     d    y    I    o    t    h     e    r    a    p    y 

temporarily.  The  drug  must  be  taken  for  months  or  . 
years.  In  a  study  of  56  cases  thus  treated  by  Jackson88, 
76  per  cent,  had  no  signs  or  symptoms  for  two  years, 
while  13  per  cent,  had  been  benefited,  and  only  6  cases 
(n  per  cent.)  could  be  considered  failures.  Within  two 
weeks  after  taking  this  drug,  improvement  was  noted  by 
diminution  of  the  palpitation,  sweating,  tremor  and 
other  nervous  symptoms.  In  many  cases  the  thyroid 
diminished  in  size,  but  the  exophthalmos  was  the  last  sign 
to  disappear  (2  or  3  years)  or  it  persisted  with  the  tremor. 

MALARIA. — A  typic  paroxysm  of  this  disease  may  be  pre- 
cipitated by  eliciting  the  splenic  reflex  of  contraction  (page 
355).  I  saw  a  case  of  latent  malaria  with  Dr.  R.  Bine,  in 
which  a  typic  paroxysm  was  precipitated  on  the  day  following 
the  elicitation  of  the  reflex. 

We  speak  of  quinin  as  the  most  effective  parasiticide 
in  this  disease  and  there  is  ample  reason  to  justify  such  a 
conclusion  but  in  this  action,  we  dare  not  ignore  the 
bactericidal  power  of  the  blood  owing  to  the  protective 
substances  or  by  anaphylaxis.  Italian  observers  claim 
that  the  present  drug-treatment  of  malaria  is  unable 
to  free  the  system  completely  of  the  malarial  parasites. 
As  long  as  the  spleen  is  enlarged  the  disease  cannot  be 
regarded  as  cured.  A  single  hypodermatic  injection  of 
15  grains  of  quinin  and  urea  hydrochlorid  will,  in  ma- 
laria, cause  a  "freedom  period"  lasting  either  6J  or  13 
days  (S.  Solis  Cohen).  A  small  dose  (0.3  to  i  gram,  at 
intervals  of  -3  days  to  one  week — about  half  a  dozen 
injections),  will  often  enable  one  to  demonstrate  plas- 
modia  in  the  peripheral  blood  although  previously  absent 
(Billings).  . 

Now,  the  action  of  quinin  is  to  increase  vagus-tone 
and,  by  so  doing,  to  contract  the  spleen.  Strychnin,  is 
likewise  a  vagus-tonic  and  within  one  hour  after  an  hypo- 
dermatic injection  of  a  therapeutic  dose,  the  plasmodia  of 
malaria  may  be  demonstrated  in  the  peripheral  blood 
although  previously  absent. 

506 


C  I  i  n  i  c  a  I    P  h  armacology 

Quinin  is  effective  in  enlargement  of  the  spleen  from 
any  cause  simply  because  it  contracts  the  organ  by 
stimulation  of  the  vagus. 

Perhaps  the  time  will  yet  arrive  when  we  shall  gauge 
the  value  of  drugs  in  malaria  according  to  their  action 
on  the  vagus  and  that  pilocarpin  or  other  efficient  vagal 
excitant  may  be  used  to  the  exclusion  of  quinin. 

In  a  case  of  splenic  leucocythemia,  I  could  always 
produce  an  enormous  increase  of  leucocytes  in  the  blood 
immediately  after  the  elicitation  of  the  splenic  reflex  of 
contraction. 

Leucocytosis,  following  the  hypodermic  injection  of 
pilocarpin,  is  essentially  mechanic  and  due  as  Kenwood, 
of  Toronto,  suggests  to  contraction  of  the  muscle-element 
in  the  spleen  and  lymph-glands. 

DIABETES. — Magyary-Kossa90 extols  the  inhalation  of 
carbon  dioxid  to  reduce  glycosuria.  In  diabetes,  dimin- 
ished vagus-tone  can  be  demonstrated  (page  479),  and 
carbon  dioxid  is  a  vagal-excitant. 

Suspension  of  respiration  for  30  seconds  or  longer 
increases  vagus-tone. 

Our  present  conception  of  shock  is  not  attributed 
to  vasomotor  failure,  but  to  acapnia  (diminished  carbon 
dioxid  in  the  blood).  Stimulation  of  the  respiratory 
center  depends  upon  carbon  dioxid  alone,  oxygen  play- 
ing a  passive  part. 

No  one  drug  in  diabetes  seems  to  have  a  curative 
influence. 

Arsenic  may  act  by  increasing  vagus-tone,  and  opium, 
bromids  and  antipyrin  probably  achieve  their  action  by 
subduing  the  neurotic  element  in  this  disease. 

Antipyrin  primarily  excites  the  vagus  for  about  5 
minutes  and  is  then  followed  by  powerful  depression  of 
the  nerve. 

The  iodids,  chloroform  and  ether,  diminish  vagus- 
tone.  The  latter  act  as  evanescent  vagal-irritants,  but 
there  is  a  marked  secondary  depression  of  tone. 

Potassium  iodid  often  acts  as  a  specific  in  asthma 

507 


Spondylotherapy 

and  this  is  probably  attained  by  diminishing  vagus-tone, 
which  in  asthma  is  increased.  Fowler's  solution  often 
prevents  iodism,  iodin  diminishes  and  arsenic  increases 
vagus-tone. 

Potassium  iodid  is  used  empirically  in  aneurysms. 
The  effects  are  probably  attained  by  diminishing  blood- 
pressure,  for  by  diminishing  vagus-tone,  the  aneurysm 
dilates.  It  may  be  that  the  latter  is  less  than  the  re- 
duction in  pressure,  otherwise  the  drug  would  do  more 
harm  than  good. 

Nasal  cocainization  elicits  an  immediate  depression 
of  vagus-tone,  whereas  the  inhalation  of  ammonia, 
increases  the  tone. 

Amyl  nitrite  inhalation  increases  vagus-tone.  This 
drug,  in  my  experience,  is  only  efficient  in  the  cardiec- 
tatic  forms  of  angina  pectoris  due  to  diminished  vagus- 
tone  (page  543). 

Sodium  cacodylate  and  mercury  are  powerful  tonics 
of  the  vagus.  The  latter  observations  invite  theorization, 
which  will  however  be  curtailed.  The  present  treatment 
of  syphilis  with  salvarsan  is  chemo-therapeutic,  and  by 
the  method  of  "therapia  sterilisans  magna,"  the  action  of 
the  drug  is  parasitotropic. 

In  syphilis,  I  have  found  diminished  tone  of  the 
vagus  and  it  is  not  improbable  that  remedies  in  this 
disease  (excepting  the  iodid),  by  increasing  the  tone  of 
the  vagus  accomplish  another  object  as  yet  not  definitely 
known. 

Reliable  preparations  of  digitalis  and  strophanthin 
given  hypodermatically  increase  the  tone  of  the  vagus. 
Within  15  minutes,  the  lung-border  may  be  made  to 
descend  double  the  distance  that  it  did  prior  to  the  in- 
jection. After  this  manner,  the  author  tests  the  relia- 
bility of  these  drugs  which  are  notoriously  unreliable. 
A  normal  subject  is  used  for  experimental  purposes. 
In  the  same  way,  one  can  predict  the  action  of  the  drugs 
on  patients. 

508 


Recapitulation 


RECAPITULATION. 

The  vagal  and  sympathetic  fibers  in  the  norm  are  in 
physiologic  antagonism.  The  ideal  vagal-stimulant  is  pilo- 
carpin,  and  the  ideal  sympathetic-stimulant  is  adrenalin. 
Atropin  diminishes  vagus-tone  by  paralyzing  the  motor  end- 
ings of  the  vagus.  Thyroid  diminishes  vagus-tone. 

Symptoms  or  diseases  (asthma,  angina  pectoris),  due  to 
increased  vagus-tone  are  acentuated  by  pilocarpin  and 
ameliorated  by  adrenalin  and  atropin. 

The  toxic  action  of  some  drugs  may  be  inhibited  by  com- 
bining them  with  their  physiologic  antagonists.  Thus  quinin 
may  be  used  with  thyroid  or  pilocarpin  with  the  iodids. 
However,  this  method  is  not  scientific,  for  we  are  adminis- 
tering synchronously  a  drug  with  its  antidote,  an  undesirable 
procedure  when  one  desires  to  test  adequately  the  physiologic 
action  of  a  medicament. 

Therapeutically,  we  employ  drugs  which  increase  vagus- 
tone  (pilocarpin)  in  diseases  which  demand  them  and  con- 
versely, drugs  which  decrease  vagus-tone  (thyroid,  iodids, 
adrenalin)  are  indicated. 


S09 


Spondylvth     e     r    a    p    y 


CHAPTER  XIV. 

FURTHER  ADVANCES  IN  THE  DIAGNOSIS  AND  TREATMENT  OF 
DISEASES   OF   THE   CIRCULATORY   SYSTEM. 

TESTS  FOR  HEART — SUFFICIENCY — KUATSU — HEART-FAILURE — FUNC- 
TIONAL CARDIAC  MURMURS — REFLEX  OF  THE  PULMONARY  ARTERY 
INHIBITION  OF  THE  HEART CARDIOPTOSIS — SUBCLAVIAN  MUR- 
MURS— ANGINA  PECTORIS — ANGINOID  PAINS — PHRENIC  NERVE — 
DIAPHRAGM  REFLEX — ANEURYSM — FLUOROSCOPY  OF  THE  AORTA. 

TESTS  FOR  HEART-SUFFICIENCY.* 

In  making  a  comparative  estimate  of  different  functional 
tests  of  cardiac  efficiency,  the  author  is  constrained  to  con- 
clude that  the  test  to  be  specified  presently  is  the  most  re- 
liable. 

Numerous  writers  confirm  the  observation  of  de  la  Camp, 
viz.,  when  the  cardiac  muscle  is  normal,  exercise  even  carried 
to'exhaustion  and  fainting  does  not  produce  dilatation  of  the 
ventricles.  On  the  contrary,  the  heart  diminishes  in  volume. 

In  myocardial  disease,  even  moderate  exercise  provokes 
ventricular  dilatation. 

In  other  words,  the  diameters  of  the  heart  are  maintained 
by  visceral-tone  (page  451).  One  first  determines  the  borders 
of  the  heart  by  percussion.  The  latter  is  facilitated  by 
forcible  extension  of  the  neck  during  the  time  percussion  is 
executed  (page  228).  Next  the  patient  is  directed  to  raise 
and  lower  the  body  a  number  of  times  (until  slight  dyspnea 
is  produced),  by  flexing  the  knees. 

*Vide  tests  on  page  215  et  seq. 

510 


Tests     f  o  r      H e  a  r  t  -  S  uffi  c  i  en  c  y 

If  percussion  (with  neck  extended),  shows  a  diminished 
area  of  cardiac  dulness,  the  myocardial  tone  is  normal  and 
the  muscle  is  efficient,  otherwise  the  tone  is  deficient  and  the 
muscle  is  inefficient.  In  percussion,  reliance  is  only  to  be 
placed  on  the  elicitation  of  the  deep  or  relative  dulness 
(forcible  percussion).  A  method  original  with  the  author  for 
testing  cardiac  tone  is  described  on  page  471. 


FIG.  118. — Illustrating  the  author's  method  of  threshold  percussion. 

The  modified  threshold  percussion  of  the  author  is 
available  for  defining  the  borders  of  the  viscera.  Per- 
cussion is  executed  in  the  mid-respiratory  position. 
The  tip  of  the  index  finger  of  one  hand  is  firmly  fixed  in 
an  intercostal  space  at  an  angle  with  the  chest-wall,  but 
parallel  with  the  boundary  that  is  to  be  percussed. 
As  the  finger  gradually  approaches  the  boundary,  it  is 
struck  with  the  middle  finger  of  the  other  hand  at  its 
base  and  side,  as  indicated  by  the  black  spot  in  fig.  118. 

Continental  writers,  notably  Zulawski91,  and  Merklen  and 
Heitz92,  find  that  when  the  heart  reflex  (page  199),  can  be 
elicited  in  myocardial  weakness,  it  indicates  a  favorable 

511 


Spondylotherapy 

prognosis.  The  former  finds  that  the  reflex  (by  irritating 
the  skin  of  the  precordial  region),  in  the  norm  reduces  the 
dulness  of  the  heart  from  i  to  \\  cm.,  and  the  latter  show 
that,  in  cardiectasis,  the  reflex  may  persist  for  several  hours.* 

My  results  are  not  in  accord  with  the  latter  observa- 
tions; it  is  the  duration  and  not  the  presence  of  the  reflex 
which  counts.  In  the  norm,  the  reflex  lasts  from  one-half 
to  three  minutes;  in  myocardial  disease,  it  may  persist  for 
hours.  In  the  latter  instance,  this  heart  reflex  of  degen- 
eration corresponds  with  the  reaction  of  degeneration, 
viz.,  a  muscular  contraction  which  is  tardy  and  persistent. 

Myocardial  disease  may  be  suspected  even  in  the  ab- 
sence of  cardiac  signs,  when  symptoms  not  unlike  those 
which  accompany  the  broken  compensation  of  valvular 
diseases  present  themselves.  A  reliable  preparation  of 
digitalis  may  solve  the  difficulty;  if,  after  five  days,  the 
symptoms  are  not  relieved  and  there  is  no  rise  of  the 
peripheral  arterial  tension  nor  increased  strength  of  the 
pulse,  the  drug  can  do  no  good  and  may  even  be  danger- 
ous. Many  preparations  of  digitalis  are  practically  inert, 
and  this  fact  may  be  demonstrated  by  its  physiologic 
action.  Within  thirty-six  hours  after  the  use  of  a  reliable 
preparation  given  in  adequate  doses,  one  finds  that  the 
pulse  becomes  stronger,  more  regular  and  slightly  de- 
creased in  frequency  (provided  the  pulse  was  accelerated 
before  the  use  of  digitalis)  and  diuresis  is  augmented. 
By  estimating  the  quantity  of  urine  excreted  one  is  af- 
forded a  guide"  in  a  dual  direction:  the  reliability  of  the 
drug  and  the  efficiency  of  the  cardiac  muscle.  In  cardiac 
muscular  insufficiency,  the  quantity  of  urine  may  be  di- 
minished by  one-half  or  more.  Owing  to  the  delayed 
action  of  digitalis,  an  increase  in  the  quantity  of  urine 
does  not  occur  until  the  second  day  of  its  use;  then  it 
continues  to  increase  day  after  day  until  the  normal  is 

*The  comparative  results  obtained  from  different  methods  for  evoking  the  heart 
reflex  are  shown  on  page  636. 

512 


Tests     for      Heart -Sufficiency 

attained  (1500  c.c.  in  twenty-four  hours  in  a  healthy 
adult) ;  at  this  time,  and  when  the  pulse  frequency  has 
been  reduced  and  the  tension  is  increased,  one  should 
withdraw  the  drug,  reduce  the  dose,  or  give  it  less  fre- 
quently. 

In  using  digitalis  for  diagnostic  or  therapeutic  pur- 
poses, the  writer  first  unloads  the  bowels  and  diminishes 
hepatic  congestion  with  a  few  small  doses  of  calomel. 
He  gives  a  reliable  fresh  infusion  of  digitalis  in  doses  of 
4  fluid  drachms  combined  with  diuretin  (sodio-theo- 
bromin  salicylate). 

Diuretin  is  administered  in  doses  of  15  grains;  it  is  a 
powerful  diuretic  and  antagonizes  the  vasoconstrictor 
components  of  digitalis.  The  more  recent  researches  of 
Lowy  seem  to  show  that  digitalis  dilates  the  coronary 
and  renal  vessels.  The  latter  pharmacologic  observation, 
however,  is  not  wholly  in  accord  with  the  clinical  results. 

It  is  often  impossible  to  differentiate  between  a  prim- 
ary myocarditis  and  a  primary  nephritis. 

If  digitalis  causes  diuresis,  one  may  conclude  that  the 
previous  oliguria  was  caused  by  a  failure  in  the  circula- 
tory apparatus,  because  its  effects  are  secured  by  its  stim- 
ulating action  on  the  heart  and  blood  vessels.  If  drugs 
like  theocin,  diuretin  and  calomel  are  effective,  we  con- 
clude that  the  effects  are  attained  by  direct  action  on  the 
renal  epithelium. 

In  the  differential  diagnosis  of  primary  myocarditis 
and  primary  nephritis,  Winternitz  has  suggested  the 
catalase  test.  In  chronic  nephritis,  the  catalase  of  the 
blood  is  destroyed,  hence,  when  the  latter  is  brought  into 
contact  with  hydrogen  peroxide,  there  is  absolutely  no 
liberation  of  oxygen  whereas  the  blood  of  patients  with 
heart  enfeeblement  splits  peroxide.  Others  concede  the 
importance  of  this  test  only  in  advanced  cases  of  nephritis 
either  in  the  uremic  or  preuremic  states. 

The  symptoms  of  broken  compensation  from  myocar- 
dial  disease  may  be  quickly  differentiated  from  a  host  of 
other  maladies  by  stimulation  of  the  myocardium  by  con- 

513 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

cussion  of  the  sevent  \  cervical  spine.  Even  within  a  few  min- 
utes after  concussion  is  executed,  cyanosis,  dyspnea  and 
other  signs  of  an  insufficient  myocardium  become  less  evi- 
dent or  disappear  for  several  hours  and  for  a  longer  inter- 
val with  repetition  of  the  concussion.  To  the  uninitiated, 
it  is  impossible  to  conceive  the  great  possibilities  of  this 
very  simple  mechanical  method  of  cardiac  stimulation. 
The  writer  has  seen  several  practically  moribund  patients 
with  pneumonia  in  whom  the  conventional  cardiac  stim- 
lants  were  employed  without  avail,  yet  these  very  pa- 
tients were  not  only  revived  but  were  revived  quickly  by 
the  method  in  question.  In  myocardial  disease,  when  it  is 
a  question  of  fortifying  the  jaded  cardiac  musculature, 
the  writer  no  longer  employs  drugs  but  relies  solely  on 
concussion  of  the  seventh  cervical  spine.  When  the  latter 
fails,  the  cardiac  musculature  is  no  longer  capable  of  res- 
titution. 

The  real  danger  with  concussion  to  elicit  the  heart  reflex 
is  its  overuse  conducing  to  exhaustion  of  the  myocardium. 
Concussion  should  only  be  used  once  a  day  until  there  is  a 
moderate  restoration  of  the  myocardium  and  then  twice  or 
thrice  weekly. 

This  over-stimulation  compromises  the  duration  rather 
than  the  amplitude  of  the  heart  reflex.  Thus,  concussion  of 
the  yth  cervical  spine  for  one  minute  gives  a  reflex  with  an 
amplitude  of  1.6  cm.,  and  a  duration  of  3  inin.  and  40  sec., 
whereas,  concussion  for  5  minutes  yields  a  reflex  with  an 
amplitude  of  2  cm.,  but  lasting  only  two  minutes. 

Recently,  the  writer  saw  a  patient  with  apex  pneu- 
monia in  consultation  with  Dr.  V.  G.  Vecki,  of  San  Fran- 
cisco, the  eminent  genitourinary  specialist.  The  patient 
was  practically  moribund.  During  the  course  of  her 
disease,  the  conventional  cardiac  stimulants  were  em- 
ployed. Suddenly  during  the  night,  however,  she  be- 
came extremely  cyanotic  and  pulseless  and  it  was  deter- 

514 


Tests     for     Heart -Sufficiency 

mined  to  concuss  the  seventh  cervical  spine  to  awaken, 
as  it  were,  the  enervated  heart.  No  percussion  appara- 
tus was  at  command  and,  in  lieu  of  the  latter,  the  palmar 
surfaces  of  the  fingers  were  applied  to  the  seventh  cervi- 
cal spine,  and,  with  the  clenched  fist,  the  dorsal  surfaces 
of  the  fingers  were  struck  a  series  of  short  and  vigorous 
blows  (Fig.  2).  The  latter  method  of  concussion  was 
continued  for  about  ten  minutes  with  intervals  of  rest. 
Soon  after  concussion  was  commenced,  the  cyanosis  be- 
came less  evident  and  the  pulse  was  again  perceptible. 
Every  two  hours  during  the  night  this  method  was  con- 
tinued and  thereafter  at  less  frequent  intervals  until  con- 
valescence was  established.  It  was  evident  to  the  nurses 
and  others  that  after  each  seance  of  the  concussion  treat- 
ment there  was  an  immediate  evanescence  of  the  cyano-  i 
sis  and  the  pulse  always  became  stronger  and  less  fre- 
quent. 

It  is  conceded  that  pneumonia  is  the  most  fatal  of  all 
acute  diseases,  tha*  there  exists  no  specific  medication,  and 
that  the  most  important  indication  is  to  maintain  the  cir- 
culation. I  am  firmly  convinced  that  the  systematic  exe- 
cution of  the  method  cited  will  prove  of  material  aid  in 
hastening  recovery  from  this  dread  disease,  which  other- 
wise may  prove  fatal. 

An  efficient  percussion  apparatus  should  be  at  the 
physician's  command  in  all  acute  diseases  and,  as  Dr. 
Vecki93  suggests,  after  operations  when  there  is  any  dan- 
ger of  cardiac  implication.  I  must  emphasize,  however, 
the  necessity  of  a  suitable  apparatus.  The  latter  must 
give  a  percussion  stroke.  All  other  motions,  such  as  os- 
cillations, shaking,  and  friction,  yield  absolutely  no  re- 
sults. 

In  a  recent  contribution94,  the  author  has  described 
Kuatsu  or  the  Japanese  method  of  restoring  life. 

Kuatsu,  or  the  restoration  of  life,  is  an  integral  part  of 
jiu  jitsu.  The  latter  is  usually  regarded  wholly  as  a 
means  of  physical  training  and  as  a  method  of  combat, 
but  when  the  victim  is  "knocked  out,"  recourse  is  had 

515 


S  p     o    n    d    y    I    o     t    h     e    r    a    p    y 

by  adepts  to  definite  methods  of  resuscitation  known  as 
kuatsu.- 

Many  centuries  ago,  when  jiu  jitsu  was  primarily  con- 
ceived in  Japan,  kuatsu  was  used  for  reviving  individuals 
who  were  rendered  unconscious  by  the  various  systems 
of  jiu  jitsu,  but  later  it  was  shown  that  kuatsu  was 
equally  effective  in  instances  of  sunstroke,  drowning,  and 
injuries  from  other  causes. 

It  is  stated  that  the  adept  in  jiu  jitsu  inflicts  no  injury 
that  cannot  be  promptly  remedied  by  the  aid  of  kuatsu, 
whereas  our  pugilists  may  inflict  blows  which  may  render 
their  opponents  unconscious  and  yet  are  unable  to  do  any- 
thing to  revive  them.  The  captious  critics  of  kuatsu 
seek  to  dispose  of  the  supposed  exaggerated  claims  of  the 
latter  by  the  derisive  observation  that  the  jiu  jitsu  man 
is  able  to  restore  those  whom  he  kills. 

The  line  of  demarcation  between  life  and  death  is 
difficult  of  determination  and  an  individual  should,  para- 
doxical as  it  may  appear,  only  be  regarded  as  dead  when 
it  is  demonstrated  that  he  is  not  alive.  The  extraordinary 
tenacity  of  life  shown  by  the  exsected  heart  is  really  mar- 
velous. By  artificial  perfusion  Kuliabko  elicited  well 
marked  contractions  of  the  entire  heart  of  the  rabbit  five 
days  after  the  death  of  the  animal,  and  the  same  author- 
ity completely  revived  the  heart  of  a  four  year  old  boy 
who  had  died  of  pneumonia  twenty-four  hours  after 
death. 

A  study  of  the  charts  in  any  representative  work*  on 
jiu  jitsu  shows  a  number  of  points  on  the  body  surface 
which,  when  struck,  will  cause  either  insensibility  or 
death.  The  writer  has  exerted  firm  pressure  over  the 
various  points  in  question  and  noted  that  in  the  majority 
of  instances  there  was  a  reflex  inhibition  of  the  heart  dur- 
ing the  period  of  pressure.  The  latter  effects  were  more 
evident  when  the  sphygmograph  was  employed.  The 

*A  representative  work  of  this  character  is  that  of  Hancock,  The  Complete  Kano 
Jiu- Jitsu.  There  are  many  systems  of  jiu-jitsu  in  Japan,  but  the  Kano  system 
has  been  adopted  by  the  government. 

516 


Tests     for     Heart -Sufficiency 

writer  has  demonstrated  elsewhere,  however,  that  the 
heart  may  be  inhibited  reflexly  practically  anywhere  on 
the  body  surface,  but  that  the  definite  points  of  election 
are  the  intercostal  spaces,  the  abdomen,  the  muscles  of  the 
neck,  and  the  region  on  either  side  of  the  spine  corres- 
sponding  to  the  upper  dorsal  vertebrae.  Irritation  of  the 
mucosa  of  the  stomach,  nose,  and  rectum  is  equally  ef- 
fective in  inhibiting  the  heart,  but,  if  the  mucous  mem- 
branes in  question  have  been  previously  cocainized,  such 
inhibition  does  not  ensue. 

Inhibition  of  the  organ  in  the  foregoing  instances, 
is  effected  by  reflex  sensory  impulses  acting  on  the  vagus, 
the  inhibitory  nerve  of  the  heart.  The  action  of  atropin 
and  pilocarpin  on  the  heart  reflex  has  been  considered 
on  page  454.  In  kuatsu,  the  subject  is  placed  in  the 
prone  posture  with  arms  extended  sideways  and  the 
operator  with  his  wrist  lands  severely  upon  the  seventh 
cervical  vertebra  with  the  regularity  of  a  carpenter  strik- 
ing with  a  hammer.  As  soon  as  the  patient  recovers  con- 
sciousness, he  is  placed  in  a  sitting  posture,  his  arms  are 
rotated,  and  he  is  aided  in  walking.  The  latter  injunc- 
tion is  regarded  as  mandatory  in  the  application  of 
kuatsu,  the  object  being  to  completely  restore  the  func- 
tions of  the  circulation  and  respiration,  otherwise,  it 
is  said  the  patient  relapses  into  unconsciousness.* 

The  resistance  of  the  myocardium  in  stretching  during 
diastole  represents  the  tonicity  of  the  cardiac  muscle. 
In  the  normal  state  stretching  of  the  cardiac  parietes  is 
effected  by  the  pressure  of  the  blood  which  enters  the 
heart  from  the  large  veins  and  is  essentially  a  venous 
pressure.  It  follows  that  in  high  venous  pressure,  pro- 
vided the  cardiac  tonicity  is  compromised,  a  cardiac 
dilatation  must  ensue.  In  the  latter  condition  the  amount 
of  residual  blood  in  the  heart  usually  exceeds  the  systolic 
output  of  the  organ. 

*The  minute  details  of  the  method  are  not  recounted  although  regarded  as  im- 
portant by  authors  on  the  subject.  In  the  opinion  of  the  writer,  the  essential 
feature  of  the  method  is  concussion  of  the  seventh  cervical  spine. 

517 


V 

Spondyloth     e    r    a    p    y 

In  the  vagus  of  the  frog  there  is  one  set  of  fibres  which 
only  influences  the  heart  rate  (chronotropic  effects), 
whereas  another  set  increases  the  force  of  the  contraction 
and  cardiac  tonicity  without  affecting  the  rate.  The 
latter  tonic  fibres  in  the  vagus  are  stimulated  by  the  usual 
cardiotonics,  but  the  action  of  the  latter  is  inhibited  if 
the  vagi  have  been  cut  or  paralyzed  by  atropin.  The 
action  of  the  cardiac  nerves  has  always  been  a  subject  of 
contention. 

The  vagus  slows  the  action  of  the  heart  (inhibitory  ac- 
tion), whereas  the  accelerator  nerves  quicken  the  action 
of  the  heart.    Both  nerves  in  the  norm  are  in  tonic  activ- 
ity. 
i 

Reference  to  Fig.  119,  shows  the  origin  and  course  of  the 
cardiac  nerves.  It  will  be  noted  that  the  spinous  process  of 
the  yth  cervical  vertebra  corresponds  to  the  3d  dorsal  seg- 
ment of  the  cord,  which  in  turn  corresponds  to  the  root- 
origin  of  the  third  thoracic  nerve. 

Concussion  is  often  a  more  powerful  nerve  stimulant  than 
electricity  and  a  blow  on  the  head  results  in  photopsia  due  to 
stimulation  of  the  optic  nerve  by  the  propagated  blow. 

In  concussion  of  the  yth  cervical  spine,  the  blow  is  trans- 
mitted through  the  spinal  nerves  to  the  sympathetic  ganglia 
which  form  in  connection  with  branches  of  the  vagus,  the 
superficial  and  deep  cardiac  plexus,  and  it  is  essentially  by 
this  indirect  stimulation  of  the  vagus  that  the  effects  are 
attained  by  concussion  of  the  yth  cervical  spine. 

Aortic  contraction  in  aneurysms  is  effected  through  the 
same  neuro-medullary  pathway. 

The  writer  has  shown  empirically  that  the  best  site 
for  stimulating  the  vagus  and  thus  increasing  the  force  of 
cardiac  contraction  and  cardiac  tonicity  is  the  spinous 
process  of  the  seventh  cervical  spine.  The  most  effective 
excitant  of  the  heart  reflex  is  concussion,  which  is  a  me- 

518 


Heart     Re fl ex    of    Dilatation 

chanical  stimulus  and  that  the  reflex  in  question  may  be 
elicited  with  the  same  certainty  and  precision  as  are  the 
reflexes  by  the  vivisectionist  in  his  laboratory. 

A  just  appreciation  of  the  latter  facts  by  the  clinician 
will  prove  of  great  value  to  him  in  the  treatment  of  myo- 
cardial  insufficiency  and  as  an  aid  in  resuscitation.  They 
also  explain  the  kuatsu  method  of  reanimation. 

In  conclusion,  I  may  say  for  academic  purposes  only 
that  the  heart  reflex  cited  is  the  heart  reflex  of  contraction. 
The  counter  reflex  of  dilation,  has  been  described  on  page 
221. 


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FIG.  119. — Origin  and  course  of  the  cardiac  nerves. — Mot,  Sens,  nuclei  of  the 
efferent  (motor)  and  afferent  (sensory)  fibers  of  the  vagus.  C,  i,  2,  3,  4,  5,  6,  7,  8, 
and  T,  i  to  8,  cervical  and  thoracic  (dorsal)  spinal  nerves.  SCO,  MCG,  ICG, 
superior,  middle  and  inferior  cervical  ganglia.  REC  LAR,  recurrent  laryngeal 
nerve;  CPL,  cardiac  plexus.  T,  3  (inclosed  in  a  circle),  corresponds  to  the  spinous 
process  of  the  seventh  cervical  vertebra  (from  Powell  and  Gibson,  slightly  modified). 

THE  HEART  REFLEX  OF  DILATATION,  elicited  by  con- 
cussion the  last  four  dorsal  vertebrae  (concussion  of  the 
loth  dorsal  spine  suffices),  is  a  dilatation  of  accommoda- 

519 


Spondyloth     e    r    a    p    y 

tion,  owing  to  an  increased  volume  of  blood  provoked  by 
such  concussion  (page  617).  Concussion  of  the  third  and 
fourth  dorsal  spines,  or  pressure  between  the  latter,  re- 
duces vagus-tone  (page  472),  and  eventuates  in  an  active 
dilatation.  The  heart  reflex  of  dilatation  is  of  little  value 
in  practice  excepting  when  the  heart  is  undersized  -(hypo- 
plasia)  in  phthisis,  advanced  valvular  disease  (specially 
the  left  ventricle  in  mitral  stenosis)  and  in  old  age  (senile 
heart).  Concussion  of  the  zoth  dorsal  spine  should  be 
executed  to  achieve  our  object. 

When  rapidity  of  action  from  drugs  is  desirable  in  diag- 
nostic-therapeutics, much  may  be  expected  from  the  in- 
travenous employment*  of  strophanthin.  Thus  adminis- 
tered, its  action  it  fully  manifested  within  sixty  minutes. 
Administered  by  the  mouth,  its  action  is  not  evident  for 
at  least  seventeen  hours.  When  it  is  remembered  that  the 
physiologic  action  of  digitalis  is  not  manifested  for  at 
least  thirty-six  hours,  it  is  not  difficult  to  note  the  many 
advantages  accruing  from  the  intravenous  employment 
of  strophanthin.  A  single  injection  of  the  latter  drug 
is  capable  of  fully  restoring  a  patient  with  cardiac  incom- 
petency.  The  dose  of  strophanthin  (a  reliable  prepara- 
tion is  that  of  Thomas)  is  from  i  to  ^  mg.  (gr.  1-240  to 
1-120).  It  is  also  procurable  in  sterile,  vials. 

In  suspected  myocardial  disease  due  to  lues,  a  positive 
Wassermann  reaction  may  prove  as  valuable  as  the  same 
reaction  in  the  diagnosis  of  luetic  aortic  insufficiency  and 
the  subsequent  therapeutic  results  with  mercury  and 
potassium  iodide  will  clinch  the  diagnosis. 

To  appreciate  the  diagnostic-therapeutic  value  of  digi- 
talis, one  must  recognize  its  action  which  may  be  divided 
into  two  periods:  (i)  therapeutic  stadium,  in  which  the 
cardiac  force  is  increased;  (2)  toxic  stadium,  when  such 

*To  make  an  intravenous  injection,  dilate  veins  of  arm  with  a  rubber  band  above 
the  elbow.  Partially  fill  syringe  (free  of  air-bubbles)  with  the  solution  and 
then  insert  needle  into  the  median  vein.  Before  injecting,  some  blood  is  drawn 
into  the  syringe  to  be  sure  that  the  needle  is  in  the  vein.  Then,  the  rubber  band 
is  removed  and  the  contents  of  the  syringe  emptied. 

520 


The     Heart     and    Its     Innervation 

force  is  diminished.  In  the  first  stadium,  slowing  of  the 
pulse  is  slight,  whereas  in  the  second  stadium,  it  is  very 
much  diminished  in  frequency,  and  may  even  become 
arrhythmic.  This  excessive  slowing  of  the  pulse  may  be 
accepted  as  the  primary  signal  of  the  toxic  action  of  digi- 
talis. The  chief  effects  of  digitalis  are  exerted  on  the 
heart  muscle,  and  the  greater  the  integrity  of  this  muscle, 
the  better  the  action  of  this  drug  on  the  heart;  hence  such 
reaction  may  be  accepted  as  a  diagnostic  indication  of 
the  condition  of  the  cardiac  muscle.  Thus,  the  more  in- 
tense the  myocardial  degeneration,  the  more  susceptible 
is  the  reaction  to  small  quantities  of  digitalis.  If,  instead 
of  securing  the  physiologic  action  of  digitalis,  toxic  effects 
are  observed,  one  would  conclude  that  the  myocardial 
changes  were  pronounced.  In  such  instances,  the  use  of 
digitalis  is  positively  dangerous. 

The  author  desires  to  emphasize  the  fact  that  there  are 
neither  exclusive  nor  specific  methods  in  therapeutics  but  that 
the  synergistic  action  of  different  remedies  must  be  conciliated. 

In  awakening  the  tonicity  of  an  enervated  heart,  the  use 
of  digitalis  with  diuretin  (page  513),  may  be  indicated  in 
association  with  concussion  of  the  yth  cervical  spine  when 
the  heart  fails  to  respond  to  the  latter  method  alone.  Con- 
cussion is  essentially  a  stimulant  to  the  vagus-fibers  which 
increase  the  contractility  (inotropic)  of  the  myocardium  and 
may  be  without  action  on  the  rhythmicity  (chronotropic 
influence),  hence  the  value  of  digitalis,  which  brings  about 
slowing  of  the  heart. 

Having  achieved  our  object  with  the  combined  digitalis- 
diuretin  prescription,  one  may  dispense  with  the  latter  and 
employ  concussion  exclusively. 

THE  HEART  AND  ITS  INNERVATION. — A  thorough 
understanding  of  this  subject  has  an  important  influence 
on  our  therapeutic  efforts.  In  addition  to  the  vagus 
nerve,  the  action  of  which  has  already  been  studied,  there 

521 


Spondylotherapy 

are  motor  fibers  from  the  sympathetic  system,  known  as 
the  accelerator  nerve  of  the  heart  (Fig.  113).  Stimulation 
of  the  latter,  causes  an  increase  in  the  rate  of  beat  of  the 
heart,  but  not  infrequently  Deforce  or  energy  of  the  beat 
may  be  increased  and  the  rate  may  remain  unaffected. 
In  consequence  of  the  latter  effects,  physiologists  assume 
that,  the  accelerator  nerve  contains  fibers  which  acceler- 
ate the  rate,  and  others  (augmentors) ,  which  cause  a 
more  forcible  beat.  Hering  has  shown  that  stimulation 
of  the  accelerators  may  revive  a  heart  that  has  ceased  to 
beat.  The  vagi  and  accelerators  are  normally  in  tonic 
activity.  Now,  cardiac  vigor  is  not  only  a  muscular  but 
a  neuro-muscular  question.  While  muscular  tone,  as  a 
rule,  is  secured  by  vagus-stimulation  (the  after-effects 
on  this  inhibitory  nerve  being  to  increase  the  force  of  the 
beat) ,  we  have  in  our  discussion  ignored  the  influence  of 
the  accelerator  nerve.  Both  nerves  are  in  physiologic 
antagonism.  In  a  given  case  of  cardiac-insufficiency,  it  is 
wise  to  test  the  tone  of  the  sympathetic  and  vagus-fibers 
according  to  the  methods  described  on  pages  469  and  472, 
to  determine  whether  our  therapy  should  be  sympathico- 
tropic  or  vagotfopic  (page  451).  In  addition  to  these 
tests,  one  may  employ  the  method  of  demonstrating 
abnormal  irritability  of  the  sympathetic  system.  In  the 
norm,  instillation  of  a  drop  of  a  one  per  thousand  solu- 
tion of  adrenalin  into  the  eye  has  no  effect  on  the  dilator 
pupillas  (page  452),  but  if  the  sympathetic  system  is  ex- 
citable, pronounced  mydriasis  follows  the  instillation 
(The  nerve-fibers  for  the  dilator  muscle  of  the  pupil  run 
in  the  cervical  sympathetic  and  terminate  in  the  superior 
cervical  ganglion) .  To  further  demonstrate  the  value  of 
the  author's  tests,  the  following  may  be  cited:  A  patient 
fond  of  coffee,  invariably  suffers  after  its  use  from  tachy- 
cardia and  arrhythmia.  Prior  to  its  use,  the  tone  of  the 
vagus  was  found  normal  (page  469).  Within  one-half 
hour  after  consuming  coffee,  the  vagus-tone  was  absent, 
the  heart  was  arrhythmic  and  the  pulse  1 20.  Within  one 
hour  after  the  use  of  pilocarpin  (gr.  i-io)  per  os  the  vagus- 

522 


Forms     of    Heart  -Failure 

tone  was  restored  to  normal,  arrhythmia  inhibited  and 
the  pulse  reduced  to  80.  The  hypodermatic  use  of  pilo- 
carpin  (page  454),  is  followed  by  more  rapid  results. 

FORMS   OF  HEART-FAILURE. 

Heart-failure  is  chiefly  a  muscular  question,  although  a 
neuro-muscular  factor  must  not  be  ignored.  In  cardiac 
insufficiency  (decompensation),  it  is  the  cardiac  muscle 
(myocardium),  which  fails  to  do  the  work  of  the  heart. 

1.  HEART-FAILURE  OF  INFLAMMATORY  ORIGIN. — This 
form  includes  inflammation  of  the  myocardium,  endocar- 
dium and  pericardium. 

One  of  the  most  common  etiologic  factors  in  the  inflam- 
matory involvement  of  these  structures  is  rheumatism.  The 
pyogenic  cocci,  pneumococcus  and  gonococcus  also  play  a 
very  important  role  in  etiology.  In  fact,  metastatic  infection 
is  exceedingly  common.  Tonsilitis,  heretofore  regarded  as 
a  trivial  affection  is  now  viewed  as  a  grave  one,  insomuch  as 
it  is  often  the  only  recognizable  cause  of  endocarditis,  poly- 
arthritis and  other  diseases. 

If  polyarthritis  is  caused  by  suppurating  tonsillar  crypts, 
incision  or  removal  of  the  latter  may  cause  an  immediate 
disappearance  of  pain  and  fever.  A  bacteriologic  study  of 
the  tonsillar  crypts  will  reveal  all  kinds  of  micro-organisms, 
and  the  wonder  is  that  the  tonsils  are  not  more  often  accused 
as  factors  in  the  etiology  of  disease. 

2.  HEART-FAILURE   OF  ARTERIOSCLEROTIC    ORIGIN. — 
The  circulatory  apparatus  must  be  regarded  as  a  unit.    In  the 
embryo,  the  heart  is  only  a  blood-vessel  and  its  elaboration 
into  a  special  organ  is  only  the  result  of  muscular  overgrowth 
which  in  one  situation  make  a  heart  and  in  another,  the  wall 
of  a  blood-vessel. 

In  arteriosclerosis,  the  hypertrophy  of  the  heart  ensues 

523 


S  p    o    n    d    y    I    o    t    h     e    r    a    p    y 

from  an  increase  in  the  peripheral  resistance  of  the  blood- 
vessels. Soon,  however,  dilatation  of  the  organ  ensues, with 
signs  of  decompensation  (dyspnea  on  exertion,  attacks  of 
cardiac  asthma,  scanty  urine,  etc.).  It  is  usual  to  specify  a 
renal  form  of  heart-failure,  but  such  a  form  is  identified  with 
arteriosclerosis  in  such  a  way  that  it  is  difficult  to  say  which 
is  primary  and  which  is  secondary. 

3.  HEART-FAILURE  FROM  OBESITY. — Oertel  first  ex- 
plained the  effects  of  obesity  on  the  heart  and  blood-vessels. 
Indeed,  heart  failure  is  more  frequently  encountered  in  fat 
than  in  lean  individuals. 

A  fatal  error  is  often  made  in  the  treatment  of  these  cases 
when  an  attempt  is  made  to  execute  a  reduction-cure  with- 
out first  strengthening  the  myocardium.  Naturally,  one 
must  eventually  reduce  the  weight,  but  care  must  always  be 
exercised  to  reduce  gradually  and  to  avoid  subalimentation. 
It  is  better  to  provide  the  patient  with  about  i  ,600  calories  a 
day  to  attain  our  goal  more  slowly. 

Thyroid  intoxication,  the  cardiac  neuroses,  in  fact  any 
cause  operating  to  increase  unduly  the  work  of  the  heart 
eventuates  in  failure  of  the  organ. 

Heart-failure  from  syphilis  (congenital  or  acquired),  is 
not   infrequent.     Some   forms   of   myocarditis   are   always 
syphilitic.     In  the  presence  of  symptoms  of  cardiac  insuffi- 
ciency in  a  subject  with  a  history  of  syphilis,  the  latter  as  an 
etiologic  factor  is  not  only  possible,  but  probable. 
Here  the  use  of  mercurial  inunctions  is  indicated : 
In  Pulmonary  Edema,  the  tonicity  of  the  right  ventri- 
cle is  implicated  and  its  dilatation  is  manifested  by  cyan- 
osis, dyspnea  and  pulmonary  edema. 

Referring  to  page  202,  one  finds  that  the  myopathic 
heart  reflex  only  influences  the  right  ventricle  of  the 
heart.  Percussion  of  the  muscles  is  a  puissant  method  of 
tieatment  in  pulmonary  edema. 

524 


Cardiac     Murmurs    of    Functional    Origin 


CARDIAC  MURMURS   OF   FUNCTIONAL   ORIGIN. 

Perhaps  no  fallacy  in  medicine  has  been  more  sacredly 
perpetuated  than  the  belief  that  a  cardiac  murmur  is  always 
indicative  of  a  disease  of  the  heart.  Some  of  the  most  serious 
heart-affections  are  unaccompanied  by  murmurs.  "The 
idea  that  a  murmur  in  itself  and  by  itself  is  a  serious  thing 
dies  hard."  (Shattuck). 

Sir  Andrew  Clark  gave  utterance  to  the  truism  that  ''a 
murmur  in  itself  is  of  little  or  no  moment  in  determining  the 
prognosis  of  any  given  case."  Osier  voices  the  opinion  of 
the  skilled  cardiac  diagnostician  as  follows:  "Practitioners 
who  are  not  adepts  in  auscultation  and  feel  unable  to  estimate 
the  value  of  the  various  heart-murmurs  should  remember 
that  the  best  judgment  of  the  conditions  may  be  gathered 
from  inspection  and  palpation.  With  an  apex-beat  in  the 
normal  situation  and  regular  in  rhythm,  the  auscultatory 
phenomena  may  be  practically  disregarded."  Fowler  is 
responsible  for  the  epigram:  "The  position  of  the  heart- 
apex  is  the  key  to  the  diagnosis  of  nearly  all  affections  of  the 
chest  and  heart." 

FUNCTIONAL  AORTARCTIA  AND  AORTECTASIS. — These 
terms  refer  respectively  to  contraction  and  to  dilatation  of  the 
aorta.  It  is  known  that,  when  the  lumen  of  an  elastic- 
walled  tube  through  which  liquid  flows  is  narrowed,  eddies 
are  created  which  cause  the  walls  of  the  tube  to  vibrate  and 
eventuate  in  a  palpable  thrill  and  a  blowing  sound  called  a 
murmur.  The  latter  is  loudest  below  the  narrowing  and  is 
transmitted  in  the  direction  of  the  flow. 

By  means  of  the  aortic  reflexes  (page  254),  one  may  con- 
tract or  dilate  the  aorta. 

If,  after  auscultating  the  aortic  sounds,  one  executes 
concussion  of  the  spine  of  the  yth  cervical  vertebra  (reflex  of 

525 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

contraction),  and  again  auscultates,  a  systolic  aortic  murmur 
is  usually  heard,  varying  in  duration  from  one-half  to  three 
minutes.  The  murmur  replacing  the  systolic  tone  is  of 
longer  duration  than  the  latter.  It  is  observed  in  the  norm 
in  children  as  well  as  in  adults  and  is  equally  pronounced  in 
arteriosclerosis  of  the  aorta.  My  primary  endeavor  to  utilize 
this  auscultatory  sign  as  an  evidence  of  loss  of  elasticity  of 
the  aorta  was  therefore  futile.  The  murmur  in  question  is 
the  result  of  temporary  aortarctia  (aortic  contraction),  super- 
induced by  elicitation  of  the  aortic  reflex  of  contraction,  and 
it  may  be  dissipated  at  once  by  provoking  the  counter  aortic 
reflex  which  dilates  the  aorta. 

In  several  instances  only,  was  the  author  able  to  create 
a  diastolic  aortic  murmur  by  elicitation  of  the  aortic  reflex  of 
dilatation. 

REFLEX  or  THE  PULMONARY  ARTERY. — As  a  rule,  simul- 
taneously with  the  creation  of  a  systolic  aortic  murmur,  a 
systolic  murmur  was  also  audible  over  the  pulmonary  artery. 
Indeed,  it  was  often  heard  in  the  latter  situation,  although 
inaudible  over  the  aorta.  It  was  specially  loud  in  children. 
Like  the  aortic  systolic  murmur,  it  was  at  once  dissipated  by 
elicitation  of  the  aortic  reflex  of  dilatation  (concussion  of  the 
4  lower  dorsal  spines).  Although  the  pulmonary  artery 
eludes  percussion,  the  auscultatory  evidence  just  cited  would 
seem  to  show  that  there  are  likewise  two  reflexes  of  the  pul- 
monary artery,  viz. — contraction  and  dilatation. 

DEDUCTIONS. — Aside  from  the  inestimable  value  of  the 
aortic  reflex  of  contraction  in  the  treatment  of  aneurysms, 
the  reflexes  of  the  pulmonary  artery  and  aorta  subserve  a 
useful  object  in  diagnosis.  Thus  dilatation  of  these  vessels 
may  exist,  for  the  calibre  of  the  large  arteries  is  never  con- 
stant. 

If,  then,  at  an  inauspicious  moment,  one  were  to  auscul- 

526 


D       e       d 


u       c       t       /        o       n 


tate  either  artery  and  a  diastolic  murmur  were  heard,  a 
faulty  diagnosis  would  be  made.  Such  diagnostic  errors  are 
frequent.  However,  having  recognized  the  physiologic 
rhythmicity  of  the  large  vessels  (page  620),  one  would  at 
once  execute  the  method  for  provoking  contraction  of  these 
vessels  by  concussion  of  the  yth  cervical  spine  and  the  dias- 
tolic murmur  would  be  dissipated  if  it  were  wholly  caused  by 
dilatation  of  the  large  vessels. 

Similarly,  a  systolic  murmur  caused  by  narrowing  of  the 
aorta  and  pulmonary  artery  would  evanesce  after  concussion 
of  the  spines  of  the  four  lower  dorsal  vertebrae. 

The  auscultatory  phenomenon  with  reference  to  the  reflex 
of  contraction  of  the  pulmonary  artery  directs  our  attention 
to  the  incorrect  apodictic  pronunciamento  of  some  physiol- 
ogists who  aver  that  the  pulmonary  blood-vessels  are 
unprovided  with  vasomotor  nerves.  From  what  has  pre- 
ceded, the  pulmonary  artery  must  be  under  vasomotor 
control. 

Dr.  H.  C.  Sawyer,  of  San  Francisco,  directed  my  attention 
to  the  fact  that  in  the  treatment  of  aneurysms  of  the  thoracic 
aorta  by  the  author's  method  of  concussion  of  the  yth  cervical 
spine,  aneurysmal  murmurs  would  disappear  for  a  variable 
period  of  time  after  treatment.  Even  the  patient  who  was 
conscious  of  the  murmur  noted  its  disappearance  for  about 
four  hours  after  treatment.  Since  my  attention  was  directed 
to  this  sign  by  Dr.  Sawyer,  I  have  also  observed  the  tempor- 
ary disappearance  of  the  thrill.  In  a  number  of  instances, 
however,  the  aneurysmal  murmur  did  not  completely  dis- 
appear, but  only  became  less  loud. 

Murmurs  are  so  commonly  encountered  without  valvular 
lesions  that  Laennec  was  constrained  to  conclude  that  they 
were  of  no  diagnostic  importance,  whatever.  Laennec's 
observation  is  worthy  of  citation,  despite  its  falsity,  in  direct- 

527 


S  p    o    n    d    y    I    o    t    h     e    r    a    p    y 

ing  attention  to  the  frequency  of  functional  or  accidental 
murmurs. 

Potain  found  accidental  murmurs  in  one-eighth  of  all  the 
patients  seen  in  his  hospital  service. 

Many  theories  have  been  suggested  in  explanation  of  the 
accidental  murmurs,  but  the  author  believes,  based  on  the 
maneuvers  suggested  for  their  creation  and  disappearance, 
that  they  are  caused  by  a  functional  stenosis  or  dilatation  of 
the  aorta  and  pulmonary  artery.  Later  (page  604),  we  shall 
learn  the  relation  of  functional  pulmonary  stenosis  to  tuber- 
culosis. 

Careful  percussion  of  the  thoracic  aorta  by  the  author, 
together  with  measurements  of  the  vessel  by  the  ortho- 
diagraph  several  times  a  day  on  the  same  patient,  show 
the  variations  in  the  calibre  of  the  aorta  in  accordance 
with  the  law  that,  each  part  of  the  body  receives  an 
amount  of  blood  necessary  for  its  activity.  The  diag- 
nosis of  murmurs  of  relative  valvular  insufficiency  has 
been  noted  on  page  209. 

INHIBITION  OF  THE  HEART  (page  228) — This  phenome- 
non may  be  utilized  in  diagnosis.  It  may  be  elicited  by  exten- 
sion of  the  muscles  of  the  neck  (Fig.  65),  or  by  contraction  of 
the  abdominal  musculature  (page  208).  The  employment  of 
the  phenomenon  is  based  on  the  fact  that  the  loudness  of  a 
murmur  is  largely  dependent  on  the  activity  of  the  heart. 
Thus,  in  weakness  of  the  heart  in  febrile  diseases  and  the 
dying  state,  murmurs  become  less  loud  or  disappear.  Dur- 
ing the  time  inhibition  is  properly  executed,  cardiac  tones 
and  murmurs  diminish  in  intensity.  A  few  seconds  usually 
elapse  before  the  effect  on  the  heart  becomes  manifest,  then, 
while  the  subject  is  still  inhibiting  the  organ,  the  heart  tones 
become  less  and  less  evident,  assuming  an  embryocardial 
character,  until  finally  they  are  no  longer  audible. 

528 


Intra-Abdominal   Insufficiency 

My  investigations  with  this  method  may  be  summarized 
as  follows: 

1.  Organic  murmurs  become  faint  and  almost  inaudi- 

ble. 

2.  Transmitted  murmurs  are  more  amenable  to  inhibi- 

tion and  when  they  are  inhibited,  the  tones  which 
they  mask  can  be  auscultated. 

3.  The  fainter  the  murmur,  the  more  easily  it  is  inhib- 

ited. 

4.  Heart-tones  are  less  amenable  to  inhibition  than 

murmurs. 

5.  Functional,  are  more  easily  inhibited  than  organic 

murmurs  and  when  tones  replace  the  murmurs, 
the  functional  nature  of  the  latter  is  determined. 

6.  Incorrect  execution  of  inhibition  will  intensify  rather 

than  diminish  murmurs  and  repetition  of  the 
maneuver  eventuates  in  futile  results  owing  to 
exhaustion  of  the  vagi. 

INTRA-ABDOMINAL  INSUFFICIENCY. — The  frequency  im- 
portance and  neglect  to  recognize  this  condition  prompts  the 
author  to  make  supplementary  observations  in  addition  to 
those  cited  on  page  145.  The  condition  in  question  is 
practically  identical  with  Glenard's  disease  (page  349),  but 
if  the  physician  is  guided  in  the  diagnosis  of  this  affection  by 
the  palpation  of  prolapsed  abdominal  viscera,  intra-abdomi- 
nal  insufficiency  will  often  escape  recognition.  In  asso- 
ciation with  the  signs  noted  on  page  145,  one  seeks  for  the 
symptoms  identified  with  intra-abdominal  venous  congestion 
(page  427). 

Cardioptosis  or  ptosis  of  the  heart  is  a  participating 
phenomenon  of  intra-abdominal  insufficiency.  The  position 
of  the  diaphragm  and  with  it  the  heart,  is  influenced  by  intra- 
abdominal  tension.  The  latter  is  maintained  by  pressure 
of  the  atmosphere  on  the  yielding  abdominal  parietes  and 

529 


S  p    o    n     d    y    I    o    t    h     e    r    a    p    y 

contraction  of  the  abdominal  muscles.  Artificial  reduction 
of  intra-abdominal  pressure  by  means  of  a  large  vacuum 
cup  applied  to  the  abdominal  wall  will  often,  as  long  as 
suction  is  maintained,  cause  the  appearance  of  systolic 
pulmonary  and  aortic  murmurs.  The  former,  however,  less 
frequent  than  the  latter. 

The  systolic  aortic  murmur  of  cardioptosis  is  associated 
with  signs  peculiar  to  the  latter,  viz.,  cyanosis,  dyspnea  on 
exertion  or  in  certain  attitudes,  and  weight  or  oppression  in 
the  lower  sternal  region  or  epigastrium.  The  disappearance 
of  the  cardiac  murmur  and  the  temporary  relief  afforded  by 
lifting  the  abdomen  and  the  almost  immediate  and  per- 
manent relief  following  the  wearing  of  a  proper  abdominal 
support,  with  the  chief  pressure  at  the  umbilical  region,  are 
diagnostic-therapeutic  signs. 

It  is  surprising  to  note  the  large  number  of  individuals 
with  neurasthenic  and  digestive  symptoms  caused  by 
intra-abdominal  insufficiency.  These  patients  are  treated 
futilely  for  every  conceivable  condition  but  the  right  one. 
In  advanced  grades  of  the  condition,  the  "habitus  enter- 
optoticus  seu  paralyticus"  may  be  recognized.  Stiller 
insists  that  a  fluctuating  or  floating  tenth  rib  (costa 
decima  fluctuans)  is  pathognomonic  of  this  condition. 
In  Stiller's  book,  "The  Asthenic  Diathesis,"  he  shows 
that  the  patients  digest  quite  well  until  fatigued.  Mucous 
colitis  is  often  associated  with  the  condition.  Mere  in- 
spection may  enable  one  to  make  a  diagnosis  when  the 
patient  is  standing,  viz.,  long  and  flat  thorax  with  narrow 
epigastric  angle,  retracted  and  flat  abdomen  in  epi- 
gastrium and  protuberant  lower  abdomen.  Prolapsed 
organs  may  be  palpated  in  the  recumbent  posture. 

These  patients  are  best  treated  by  hyperalimentation 
and  an  abdominal  support.  We  must  not  forget  however, 
that  the  victims  of  intra-abdominal  insufficiency  may  be 
obese  as  well  as  emaciated. 

530 


Intra  -  Abdominal   Insufficiency 

Before  a  permanent  abdominal  support  is  obtained, 
one  may  temporize  with  Rose's  method  of  strapping  the 
abdomen  for  determining  whether  gastric,  cardiac,  neu- 
rasthenic and  other  symptoms  are  dependent  on  intra- 
abdominal  insufficiency.  The  plaster  may  be  worn  for 
a  week  or  longer.  Z.  O.  adhesive  plaster  on  moleskin 
'  (Johnson  and  Johnson)  is  used,  seven  inches  wide  and 
as  long  as  the  circumference  of  the  waist  measure  of  the 


FIG.  120. — Illustrating  the  method  of  Rose  in  the  application  of  the  plaster 
bandage.  The  figure  above  shows  the  method  of  cutting  the  plaster  and  the  other 
figures  show  respectively,  the  method  of  applying  the  strip  A,  and  the  strips  B,  B, 
which  complete  the  bandage. 

patient.  This  plaster  is  cut  into  three  pieces  according 
to  figure.  The  abdomen  is  shaved  and  washed  with 
ether.  The  large  piece  is  first  applied,  the  point  being 
placed  over  the  symphysis,  the  ends  meeting  and  over- 
lapping in  the  back.  The  plaster  should  be  applied 
above  the  crest  of  the  ilium.  Then  the  side-pieces,  which 
run  from  the  hypogastrium  over  the  iliac  and  inguinal 
regions  and  unite  at  the  spine,  are  applied  with  consid- 
erable force. 

531 


Spondyloth     e     r    a    p    y 

I  usually  apply  the  plaster  in  the  Trendelenburg  posi- 
tion although  the  dorsal  posture  may  be  used,  the  ab- 
dominal viscera  being  raised  by  an  assistant  during  the 
time  the  plaster  is  tightly  approximated  to  the  back. 
The  removal  of  the  plaster  is  facilitated  by  benzine  or  oil 
of  wintergreen. 

Another  method100,  more  satisfactory  than  the  latter 
for  supporting  the  abdomen  is  the  following  which  is 
illustrated  in  Fig.  121. 


FIG.  121. — Illustrating  a  method  for  supporting  the  abdomen.     A  indicates 
double-padded  bandage  and  B,  zinc  oxid  strip. 

"A  strip  of  zinc  oxid  adhesive  plaster  2  or  z\  inches 
wide  and  about  5  or  6  inches  long,  the  length  varying  with 
the  size  of  the  patient,  is  placed  transversely  across  the 
extreme  lower  abdomen  as  nearly  as  possible  to  the  pubes, 
the  hair  having  been  shaved  clean  for  this  purpose.  To 
each  end  of  this  strip  of  adhesive  plaster  is  attached  a 
bandage  of  about  the  same  width,  long  enough  to  reach 
around  the  body  above  the  iliac  crest,  and  be  tied  or 
otherwise  fastened  behind,  or  better,  one  end  long  enough 
to  reach  around  and  fasten  at  opposite  end  of  plaster. 
If  the  ends  of  the  plaster  have  a  tendency  to  become 
loosened  and  pull  up  by  traction  of  the  bandage,  this 
can  be  prevented  by  a  narrow  verticle  strip  across  each 
end  of  the  adhesive  strap  and  applied  to  the  skin  above 
and  below.  The  bandage  itself  is  well  padded  with  cot- 
ton, either  folded  within  it  or  applied  to  the  body  imme- 

532 


Subclavian     Murmurs 

diately  beneath  it.  This  prevents  any  irritation  of  the 
skin  from  the  bandage  and  permits  of  its  being  drawn 
as  tightly  as  necessary  in  order  to  furnish  the  necessary 
support  from  below." 

The  point  of  pressure  in  the  lower  abdominal  area 
gives  the  greatest  amount  of  support.  Where  the  plaster 
approximates  the  skin,  a  thin  layer  of  collodion  to  the 
latter  may  precede  the  application  of  the  bandage. 

Any  abdominal  condition  causing  the  diaphragm  to  be 
forced  upward  may  cause  functional  murmurs  and  the  hori- 
zontal position  of  the  heart  with  an  apparent  increase  in  the 
transverse  diameter  may  still  further  complicate  the  situation. 

SUBCLAVIAN  MURMURS. 

Subclavian  murmurs  are  frequently  misinterpreted  as 
evidence  of  an  aneurysm  or  cardiac  disease.  The  literature 
on  the  subject  is  meager  and  indefinite  and  for  that  reason  I 
may  be  pardoned  for  interpolating  my  investigations. 

From  the  literature  the  following  facts  were  gleaned: 
Subclavian  murmurs  are  sounds  heard  over  the  sub- 
clavian  artery  which  are  dependent  on  the  phases  of 
respiration.  They  are  usually  best  heard  at  the  height 
of  inspiration,  less  often  at  the  end  of  expiration.  When 
very  intense,  they  may  be  recognized  by  the  finger  as 
fremissement.  They  are  heard  more  often  on  the  left  than 
on  the  right  side,  rarely  on  both  sides,  and  least  often  on 
the  right  side.  English  practitioners  of  medicine  have 
been  especially  prominent  in  the  study  of  the  phenome- 
non, and  have  regarded  it  as  a  clinical  sign  of  pulmonary 
tuberculosis  when  it  is  only  manifest  on  one  side.  This 
opinion  was  combated  by  Fuller  and  Palmer.  The 
former  found  the  subclavian  murmur  twelve  times  among 
one  hundred  healthy  persons,  whereas  Palmer  found  it 
to  exist  thirty-seven  times  among  one  hundred  and 
twenty-nine  healthy  laborers. 

533 


SpGndylotherapy 

MECHANISM  OF  THE  SUBCLAVIAN  MURMUR. — The 
mechanism  of  its  origin  has  not  been  made  definite,  al- 
though it  has  been  variously  attributed  to  compression 
of  the  subclavian  artery  by  the  elevation  of  the  first  rib 
in  inspiration  or  to  the  action  of  the  subclavius  and 
scaleni  muscles.  Friedreich,  observed  the  subclavian 
murmur  most  frequently  among  phthisical  individuals, 
and  suggested  as  a  cause,  the  occurrence  of  adhesions  be- 
tween the  vessel  wall  and  the  lung  pleura,  which  led  to  a 
narrowing  of  the  artery  in  one  or  both  phases  of  respira- 
tion. He  contended  that,  insomuch  as  pleural  adhesions 
were  not  infrequent,  even  among  healthy  persons,  he  was 
constrained  to  conclude  that  such  adhesions  sufficed  to 
explain  all  subclavian  murmurs,  the  extent  and  direction 
of  the  synechiae  determining  the  occurrence  of  the  mur- 
mur during  inspiration  or  expiration.  From  an  exam- 
ination of  more  than  three  hundred  persons,  I  am  able 
to  formulate  the  following  conclusions: 

i  The  subclavian  arterial  murmur  is  an  independent 
(autochthon)  and  rarely  a  transmitted  murmur. 

2.  Its  point  of  maximum  intensity  is  the  fossa  of 
Mohrenheim,    with    feeble    tendency    to    propagation. 
The  fossa  of  Mohrenheim  is  that  depression  under  the 
clavicle  in  the  outer  part  of  the  infraclavicular  region  be- 
tween the  pectoralis  major  and  deltoid  muscles. 

3.  It  is  heard  most  often  on  the  left  side,  less  fre- 
quently on  both  sides,  and  least  frequently  on  the  right 
side.    In  order  of  frequency  it  is  heard  at  the  height  of 
inspiration,  at  the  end  of  expiration,  and  after  momen- 
tary suspension  of  respiration. 

4.  It  is  usually  a  succession  of  murmurs  uniform  in 
character  and  intensified  by  certain  maneuvers,  notably 
deep  inspiration,  forced  expiration,  suspension  of  respir- 
ation, and  voluntary  stretching  of  the  neck. 

5.  One  of  the  chief  characteristics  is  its  momentary 
duration,  disappearing  usually  after  a  few  deep  inspira- 
tions. 

534 


Anatomic     Conditions 

6.  Its  dependence  on  the  phases  of  respiration  dis- 
tinguishes it  from  all  transmitted  murmurs. 

7.  It  may  be  present  at  one  and  absent  at  a  subse- 
quent examination,  and  neither  its  character  nor  dura- 
tion is  ever  uniform  from  one  examination  to  another. 

8.  The  position  of  the  patient  may  influence  its  gen- 
esis, but  this  is  never  sufficiently  uniform  to  be  of  prac- 
tical value. 

9.  A  phthisical  lung  is  not  specially  propitious  to  its 
occurrence,  as  it  is  found  nearly  as  often  in  healthy  as  in 
phthisical  persons. 

10  It  was  present  in  36  per  cent,  of  all  healthy  per- 
sons examined,  advantage  being  taken  in  this  enumera- 
tion of  re-examinations  and  those  propitious  factors 
which  determine  its  occurrence,  viz.,  respiration  and 
decubitus. 

1 1 .  The  venous  subclavian  murmur  was  only  heard  in 
six  individuals  with  a  preponderance  of  its  occurrence  on 
the  right  side. 

12.  The  arterial  subclavian  murmur  could  be  artifi- 
cially induced  on  the  left  side  in  nearly  80  per  cent,  of  all 
individuals  examined,  and  on  the  right  side  in  about  65 
per  cent,  of  the  cases  by  a  simple  maneuver,  viz.,  raising  the 
arm  gradually  until  it  assumes  a  vertical  position,  while 
auscultating  the  Mohrenheim  fossa  during  the  time  that 
the  arm  is  brought  to  the  latter  position,  the  murmur 
suddenly  appearing  at  some  time  during  the  execution  of 
the  movement. 

13.  By  the  foregoing  maneuver  the  subclavian  venous 
murmur  could  be  induced  on  the  right  side  in  43  per  cent, 
of  all  persons  examined. 

ANATOMIC  CONDITIONS. — To  explain  the  origin  of  the 
subclavian,  arterial,  and  venous  murmurs,  a  short  ex- 
cursion into  the  realms  of  anatomy  is  necessary.  The 
right  subclavian  artery  arises  from  the  arteria  innominata 
whereas  the  same  vessel  on  the  left  side  arises  from  the 
end  of  the  transverse  portion  of  the  arch  of  the  aorta. 
The  left  subclavian  artery  is  longer  than  the  right  and 

535 


S   p    o    n    d    y    I    o     t    h     e     r    a   p    y 

directed  almost  vertically  upward,  instead  of  arching 
outward,  like  the  vessel  of  the  opposite  side.  The  inner 
aspects  of  the  upper  lobes  of  both  lungs  are  occupied  by 
grooves,  one  on  each  side,  for  the  subclavian  vessels, 
where  they  are  invested  by  the  pleura.  The  third  por- 
tion of  each  subclavian  artery  on  the  outer  surface  of  the 
first  rib,  and  at  the  lower  border  of  this  bone  becomes 
the  axillary  artery.  The  points  in  connection  with  the 
first  rib  that  suggest  attention  are  the  tubercle  and  ridge, 
which  serve  for  the  attachment  of  the  scalenus  anticuc 
muscle,  the  groove  in  front  of  it  transmitting  the  subclav- 
ian vein,  that  behind  it  the  subclavian  artery.  Both 
subclavian  veins,  which  are  the  continuation  of  the  axil- 
lary veins,  unite  with  the  internal  jugulars  to  form  the 
right  and  left  vena  innominata.  If  we  auscultate  the 
subclavian  artery,  we  hear,  in  the  majority  of  cases,  just 
as  we  do  in  listening  over  the  carotid,  two  clear  tones, 
one  corresponding  with  the  filling  of  the  vessel,  the  dias- 
tolic,  and  the  other  with  the  emptying  of  the  vessel,  the 
systolic  tone.  Less  often  only  one  tone  is  heard,  which 
is  usually  coincident  with  the  systole  of  the  blood-vessel. 
The  tones  thus  heard  are  the  transmitted  first  and  second 
aortic  tones.  If  we  press  moderately  with  the  stetho- 
scope, let  us  say,  the  carotid  artery,  we  hear  a  pressure- 
murmur  corresponding  to  the  arterial  pulse;  by  stronger 
pressure,  which  almost,  but  not  quite,  closes  the  artery, 
this  murmur  is  changed  into  a  tone,  the  so-called  pres- 
sure-tone. With  these  preliminary  facts  at  our  disposal, 
we  can  make  explicable  the  subclavian  murmur  as  heard 
in  health.  The  following  facts  demand  solution: 

1.  Why  is  the  subclavian  murmur  heard  loudest  dur- 
ing forced  inspiration  and  expiration? 

2.  Why  is  the  murmur  of  short  duration,  disappear- 
ing after  a  few  deep  inspirations? 

3.  Why  is  the  murmur  heard  more  often  on  the  left 
than  on  the  right  side? 

FACTORS  NECESSARY  FOR  ITS  PRODUCTION. — The  es- 
sential factor  necessary  in  the  production  of  the  subclav- 

536 


Anatomic     Conditions 

ian  murmur  is  a  moderate  narrowing  of  the  lumen  of  the 
blood-vessel.  The  recorded  frequency  of  the  subclavian 
murmur  in  phthisis,  and  its  explanation  that  pleural 
adhesions  are  responsible  for  its  occurrence,  is  in  a  meas- 
ure untenable,  for  such  a  condition  presumes  a  narrow- 
ing of  the  blood-vessel  that  would  be  persistent  at  some 
phase  of  the  respiratory  act.  My  observations  show 
that  the  murmur  occurring  in  phthisis  is  just  as  transitory 
as  it  is  in  health.  Moderate  narrowing  of  the  subclavian 
artery  occurs  during  forced  inspiration.  This  is  a  fact 
which  is  easily  demonstrable  in  almost  any  individual  by 
palpation  of  the  radial  pulse.  In  not  a  few  instances 
deep  inspiration  will  cause  the  radial  pulse,  especially 
the  left,  to  disappear.  The  paradoxic  pulse  has  lost  much 
of  its  clinical  significance  as  a  diagnostic  aid  in  med- 
iastino-pericarditis,  since  observations  have  shown  that 
in  health  distinct  respiratory  changes  in  the  pulse  are 
demonstrable  by  means  of  the  sphygmograph.  The 
sphygmogram  shows  a  fall  in  the  pulse-curve  during  in- 
spiration and  a  rise  during  expiration.  Deep,  prolonged 
inspiration,  by  elevating  the  first  rib,  effects  compression 
of  the  subclavian  artery,  which  accounts  for  the  murmur, 
which  is  really  a  pressure-murmur.  Violent  contraction 
of  the  muscles  of  inspiration  or  forced  contraction  of  the 
muscles  which  draw  the  shoulder  forward  while  the  arm 
is  at  the  side  will  change  the  murmur  into  a  tone — the 
pressure-tone.  The  occurrence  of  the  murmur  only  dur- 
ing expiration  may  be  explained  in  part  by  the  fact  that 
after  the  artery  is  excessively  compressed  by  the  act  of  in- 
spiration, this  pressure  is  in  part  removed  during  the  be- 
ginning of  expiration,  which  act  converts  a  pressure-tone 
into  a  pressure-murmur.  Then  again  the  blood-pressure 
must  be  taken  into  account  during  the  expiratory  act. 
Stretching  of  the  neck,  which  will  sometimes  elicit  the 
murmur,  is  explained  by  the  action  of  the  scalenus  med- 
ius  elevating  the  fifth  rib.  The  short  duration  of  the 
murmur  finds  explanation  in  the  artificial  production  of 
the  pressure-murmur  in  the  normal  artery.  Here,  as  in 

537 


Spondylotherapy 

the  normal  artery,  the  ever-increasing  narrowing  of  the 
lumen  of  the  subclavian  artery  will  convert  a  murmur 
into  a  tone.  This  is  practically  what  occurs  during  forced 
inspiration,  for  a  murmur  heard  during  the  beginning  of 
the  inspiratory  act  may  no  longer  be  audible  at  the  end 
of  that  act.  Then  again  attention  must  be  directed  to  a 
condition  (page  299),  which  Kernig  and  myself  have 
described,  viz.,  a  complete  dulness  of  the  lung-apices 
without  any  structural  change  in  the  lung.  In  many 
healthy  persons  this  condition  is  manifest.  It  is  not 
difficult  to  conceive  that  the  subclavian  artery  would  be 
.  more  effectually  compressed  by  an  atelectatic  upper 
lung-lobe  than  by  an  aerated  lobe.  After  a  few  deep 
inspirations  th^  subclavian  murmur  is  no  longer  evident, 
owing,  perhaps,  to  the  fact  that  the  apices  becoming 
more  aerated  offer  less  resistance  to  the  superimposed 
arteries.  The  more  frequent  occurrence  of  the  murmur 
on  the  left  side  finds  facile  explanation  in  the  anatomic 
differences  between  the  two  arteries;  the  left  reacting 
more  easily  than  the  right  subclavian  artery  to  the  in- 
fluence of  those  factors  which  conduce  to  compression  of 
the  blood-vessels. 

MEANS  BY  WHICH  THE  MURMUR  MAY  BE  ELICITED. — 
The  method  I  have  advocated  for  eliciting  the  subclavian 
murmur  is  simple.  Placing  the  pectoral  end  of  our 
stethoscope  in  the  fossa  of  Mohrenheim,  we  listen  for  the 
subclavian  murmur.  If  the  latter  is  not  heard,  we  slowly 
raise  the  arm  of  the  patient  corresponding  to  the  side 
auscultated  until  it  is  audible.  The  murmur  may  not  be 
demonstrable  until  the  arm  is  elevated  to  a  level  with  the 
shoulder  or  until  it  assumes  a  vertical  position.  This 
maneuver  evokes  the  subclavian  phenomenon  by  narrow- 
ing the  lumen  of  the  subclavian  artery,  for  coincident  with 
the  elevation  of  the  arm  the  radial  pulse  becomes  less  and 
less  evident,  until,  when  the  arm  has  attained  the  vertical 
position,  the  pulse  is  no  longer  palpable.  This  diminu- 
tion in  the  pulse-volume  is  more  manifest  on  the  left  than 
on  the  right  side.  In  a  certain  percentage  of  persons  ex- 

538 


Angina         Pectoris 

amined,  the  maneuver  of  raising  the  arm  gave  rise  to  a 
subclavian  venous  instead  of  an  arterial  murmur,  while 
in  other  persons  both  murmurs  were  distinctly  audible. 
The  soft,  musical,  continuous  hum  of  the  venous  mur- 
mur cannot  be  confounded  with  the  arterial  murmur. 
Like  the  artificial  venous  murmurs  produced  by  pressure 
of  one  of  the  large  veins  by  means  of  our  stethoscope,  so 
may  the  subclavian  venous  murmur  be  explained,  viz., 
that  by  raising  the  arm  we  elevate  the  first  rib,  which  in 
turn  narrows  the  subclavian  vein.  The  more  frequent 
occurrence  of  the  subclavian  venous  murmur  on  the 
right  side  is  explained  in  the  same  way  as  we  explain  the 
increased  irequency  of  the  jugular  venous  murmur  on 
the  same  sfde. 

ANGINA  PECTORIS.* 

Anginoid  pains  are  symptomatic  of  a  variety  of  cardiac 
affections  and  are  equally  independent  of  the  latter.  We 
shall  first  differentiate  the  so-called  varieties  of  angina 
pectoris  (stenocardia). 

1.  ANGINA  ABDOMINIS. — Here,  the  spasm  is  confined  to 
the  vessels  innervated  by  the  splanchnic  nerve,  causing  an 
enormous  increase  of  blood-pressure.     Even  in  true  angina 
there  are  attacks  of  abdominal  pain  suggesting  gall-stone 
colic. 

2.  ANGINA  PECTORIS  VASOMOTORIA. — Here,  there  is  no 
primary  cardiac  lesion,  but  a  wide-spread  arterial  spasm 
with  secondary  anginoid  pains.     The  peripheral  angiospasm 
causes  paresthesias  in  the  hands  and  feet,  and  if  the  pale 
and  cold  (often  cyanotic)  extremities  are  warmed,  or  if  the 
patient  walks,  anginoid  pains  are  inhibited. 

3.  ANGINA  PECTORIS  FROM  CORONARY  SCLEROSIS. — In 
this  true  form  of  the  disease  the  lesion  in  the  majority  of 

*Vide,  page  221,  et  seq. 

539 


S  p    o    n     d    y    I    o     t    h     e    r    a    p    y 

instances  is  an  arteriosclerosis  of  the  coronary  arteries.  The 
pains  are  probably  caused  by  an  ischemia  of  the  myocar- 
dium (page  222),  which  fact  is  supported  by  the  observation 
that  the  pains  diminish  in  frequency  as  age  advances,  owing 
either  to  muscular  insufficiency  or  because  the  too-rigid 
vessels  do  not  permit  of  vasoconstriction. 

ETIOLOGY  OF  ANGINOID  PAINS. — Practically  any  painful 
abdominal  affection,  notably  gastric  ulcer,  may  simulate  the 
pains  of  angina  pectoris.  In  endocarditis  and  perhaps  in 
obesity  (if  coronary  arteriosclerosis  is  not  present),  narrowing 
of  the  coronary  vessels  may  conduce  to  attacks  of  angina. 
Pericardial  adhesions  may  also  narrow  the  lumina  of  the 
vessels.  Syphilis  of  the  heart  is  not  an  infrequent  factor. 
Probably  the  lesion  is  more  often  aortic  (implication  of  the 
region  corresponding  to  the  origin  of  the  coronary  arteries). 
Here,  antisyphilitic  treatment  may  establish  the  diagnosis. 
Tabes  dorsalis  (cardiac  crises),  gout,  diabetes,  lead  poisoning, 
hyperthyroidism,  autointoxication  and  nervous  affections  may 
cause  anginoid  pains. 

Tobacco  is  no  doubt  a  frequent  etiologic  factor  in  angina. 
When  tobacco  or  alcohol  is  the  problematic  cause,  the  pres- 
ence of  scotomata  (blind  spots  in  the  visual-field),  will  clinch 
the  diagnosis. 

Test  for  scotomata. — Let  patient  with  one  eye  closed 
look  steadily  at  tip  of  physician's  nose  at  a  distance  of 
about  two  feet;  then  take  any  green  or  red  colored  object 
(wool  or  card  board) ,  about  2  to  5  mm.  in  diameter,  and 
move  it  from  the  periphery  to  the  point  of  fixation;  when 
the  object  arrives  at  the  scotoma  (seat  of  defect  in  the 
visual-field),  it  will  appear  dull  or  colorless.  Green  is 
usually  less  readily  perceived  than  red. 

Osler,9S  presages  an  increasing  number  of  cases  of  angina 
pectoris  (cardiac  neuralgia),  corresponding  with  the  rapid 

540 


Angina 


c    t    o    r    /    s 


increase  of  cigarette  smoking  among  women.    He  observes 
that  very  heavy  smokers  may  die  from  vagus-inhibition. 

In  investigating  the  influence  of  tobacco  on  the  heart,  I 
noted  that  in  some,  individuals  the  blood-pressure  was  re- 
duced and  in  other  instances,  it  was  raised.  The  effects 
thus  produced  corresponded  to  its  sedative  or  stimulating 
action.  The  chief  effect,  however,  was  on  the  cardiac 
musculature,  tobacco  eliciting  a  veritable  heart  reflex  lasting 
from  one  minute  to  several  hours.  This  effect  was  accent- 
uated when  the  tobacco  was  inhaled  and  partially  inhibited 
when  the  smoke  was  filtered  through  cotton.  The  effects 
varied  with  the  kind  of  tobacco  smoked.  Thus,  in  some 
individuals,  Havana  tobacco  produced  a  marked  retraction 
of  the  left  ventricle,  whereas,  Turkish  tobacco  was  without 

any  effect. 

In  my  investigations,  the  effects  of  tobacco  were  not 
only  tested  with  reference  to  the  heart  reflex  but  by  other 
methods  for  testing  vagus-one  (page  469). 

Insomuch  as  tobacco  is  a  vagus-tonic,  I  do  not  pro- 
hibit its  use  among  my  patients  who  suffer  from  aneur- 
ysmsormyocardial  affections  (excluding  angina  pectoris). 

To  illustrate  my  investigations,  the  following  two  cases 

are  cited: 

CASE  I 

AMPLITUDE  OF 


a.  Havana  cigar  partially  smoked 

b.  Same  cigar  smoked  through 

cotton  in  a  holder 

c.  Manila  cigar  without  cotton 

d.  Manila  cigar  with  cotton 


RETRACTION  OF 
LEFT  VENTRICLE 

o.    3.5  cm. 


DURATION  OF 
HEART 
REFLEX 

a.    2  min. 


b. 

c. 

d. 


No  retraction. 
4  cm. 
2  cm. 


4  mm. 
3  min. 


CASE  II 


Same  condition  as  a 
Same  condition  as  b 
Same  condition  as  c 
Same  condition  as  d 


2.5  cm. 

No  retraction. 

4  cm. 

No  retraction. 


2  mm. 
7  min. 


541 


S  p     ondyloth     e    r    a    p    y 

It  is  quite  probable  that  anginal  pains  from  tobacco  are 
caused  by  ischemia  of  the  myocardium  superinduced  by 
the  heart  reflex. 

Anginoid  pains  are  not  infrequent  in  aneurysms  and 
Osier  refers  to  angina  pectoris  as  an  early  symptom  of  the 
disease,  due  probably  to  overstretching  of  the  aorta. 

Here,  concussion  of  the  seventh  cervical  spine  (which 
contracts  the  aorta),  will  cause  an  immediate  evanescence  of 
the  pain,  whereas,  the  maneuver,  which  likewise  contracts 
the  heart  will  increase  the  pains  in  true  angina  (page  223). 

With  increasing  experience  in  the  treatment  of  angina 
pectoris,  the  author  is  constrained  to  make  a  dogmatic 
differentiation  of  the  disease  into  two  forms :  Angina,  with- 
out and  with  an  increase  in  the  diameters  of  the  heart. 

ANGINA  WITHOUT  DILATATION. — It  is  not  only  necessary 
to  demonstrate  that  the  heart  is  not  dilated,  but  also  to 
establish  the  fact  by  the  method  cited  on  page  510,  that  the 
myocardium  is  efficient.  When  the  myocardium  is  efficient 
and  the  heart  is  not  dilated,  the  angina  is  probably  caused  by 
coronary  arteriosclerosis.  If  examination  shows  a  dilatation 
of  the  organ  and  an  inefficient  myocardium,  the  pains  are 
caused  by  an  acute  or  chronic  dilatation  of  the  heart. 

I  shall  differentiate  these  two  forms  as  cardio-tonic  (no 
increase  in  cardiac  diameters),  and  cardiectatic  angina 
pectoris. 

The  tone  of  the  myocardium,  as  has  already  been  shown 
(page  471),  is  maintained  by  vagus-tone,  and  any  increase 
in  the  latter  will  precipitate  a  cardio-tonic  paroxysm  of 
angina.  It  is  in  this  way  only  that  one  may  explain  attacks 
caused  by  the  action  of  digitalis,  pilocarpin  and  concussion 
of  the  yth  cervical  spine,  which  increase  vagus-tone.  Atropin 
inhibits  the  pains  of  the  cardio-tonic  variety  and  accentuates 
the  pains  of  the  cardiectatic  forms. 

542 


Cardiectatic     Angina      Pectoris 

Concussion  of  the  yth  cervical  spine  will  cure  the  car- 
diectatic  forms. 

By  inhibiting  vagus-tone  (concussion  or  sinusoidalization 
of  the  region  corresponding  to  the  third  and  fourth  dorsal 
spines),  the  author  has  achieved  promising  results  in  the 
treatment  of  cardio- tonic  angina  pectoris.  This  corresponds 
to  the  method  on  page  221,  for  eliciting  the  heart  reflex  of 
dilatation;  the  dilatation  by  this  method  being  to  evoke  an 
active  dilatation  of  the  organ  (page  520). 

CARDIECTATIC  ANGINA  PECTORIS. — Investigations  by 
Hyde,  in  Porter's  laboratory,  show  that  dilatation  of  the  heart 
alone  will  diminish  the  flow  of  blood  through  the  coronary 
arteries.  It  is  for  the  latter  reason  that  the  pains  associated 
with  dilatation  may  be  subdued  by  withdrawing  some  blood. 

Among  the  soldiers  of  the  Civil  war,  da  Costa  noted 
precordial  pains  of  anginoid  intensity,  due  to  overstrain  and 
dilatation  of  the  heart.  Acute  cardiac  dilatation,  such  as  is 
observed  after  physical  exertion  (climbing,  dancing,  rowing, 
running,  etc.),  causes  anginoid  pains. 

Within  a  few  days,  treatment  by  concussion  causes  the 
disappearance  of  symptoms  peculiar  to  dilatation  of  the 
heart. 

The  following  case  of  a  San  Francisco  physician  is 
cited  to  illustrate  the  importance  of  recognizing  the 
cardiectatic  variety  of  angina  pectoris.  My  stenog- 
rapher's verbatim  report  from  the  physician  is  as  follows: 
"My  age  is  52  and  weight,  172  pounds.  Several  promi- 
nent physicians  (names  suppressed)  diagnosed  my  case 
as  one  of  true  angina  pectoris  and  I  was  doomed  to  live 
a  life  of  hopeless  invalidism.  My  father  suffered  from 
similar  attacks  of  anginal  pains  which  began  at  my  age. 
He  was  like  myself  inclined  to  obesity.  I  am  forced  to  give 
up  my  outside  practice,  because  the  least  exertion  in 
walking  and  particularly  when  the  cold  air  strikes  my 

543 


Spondyloth     e     r    a    p    y 

chest  brings  on  severe  and  radiating  pains  with  a  feeling 
of  fear  and  oppression." 

In  this  patient,  the  cardiectatic  variety  of  angina  was 
demonstrated.  Within  three  weeks,  the  patient  was  able 
to  resume  his  practice  and  up  to  the  time  of  writing 
could  make  any  physical  exertion  without  any  recurrence 
of  symptoms.  Concussion  of  the  seventh  cervical  spine 
(daily  seances,  ten  minutes)  was  the  only  treatment  em- 
ployed. Provision  later,  however,  was  made  for  a  grad- 
ual reduction  in  weight  for  it  is  impossible  to  fully  re- 
construct cardiac  musculature  immersed  in  an  at- 
mosphere of  fat.  The  fact  that  the  patient's  father  had 
similar  attacks  at  his  age  only  emphasized  heredity  in 
relation  to  the  tendency  to  corpulency  which  impaired 
the  integrity  of  the  cardiac  musculature. 

The  fact  in  the  previous  history,  that  "cold  air  striking 
the  chest"  precipitated  an  attack,  led  me  to  investigate  this 
phenomenon  which  is  by  no  means  uncommon  in  angina 
pectoris.  Some  patients  also  suffer  from  attacks  when  cold 
air  is  inspired.  I  found  that  when  a  current  of  cold  air  is 
directed  over  the  precordial  region,  the  heart  dilates.  In  the 
norm  this  dilatation  is  slight,  but  it  is  exaggerated  in  cardiac 
insufficiency.  Inhalation  of  cold  air  produces  a  like,  though 
less  pronounced  effect.  This  heart  reflex  of  dilatation  (pages 
221  and  520),  like  its  counter  reflex  of  contraction,  is  mediated 
by  the  vagus,  for,  when  the  latter  is  inhibited  (pressure 
between  the  3d  and  4th  dorsal  spines),  no  reflex  can  be  elicited 
A  current  of  warm  air  over  the  heart  is  neutral  in  action. 

The  foregoing  observation  is  of  great  physiologic  and 
therapeutic  value.  As  a  rule,  cold  air  impinging  on  a 
visceral  area  is  in  the  nature  of  a  cutaneous  irritant  and 
one  would  premise  that  the  result  would  be  a  contraction 
of  an  organ,  like  the  heart  reflex  of  contraction  and  other 
visceral  reflexes.  It  was  found  that  cold  air  similarly  used, 
dilated  the  stomach,  spleen  and  liver.  The  physiologist 

544 


Differential   Diagnosis    of  Chest-Pain 

has  extended  the  scope  of  the  cutaneous  sensory  nerves 
by  not  only  endowing  them  with  the  sensation  of  touch, 
but  of  pressure,  warmth,  cold  and  pain.  He  must  now 
recognize  the  puissance  of  specific  cutaneous  nerves 
(page  465),  which  influence  visceral-tone;  nerves,  which 
in  response  to  a  special  irritant,  will  either  contract  or 
dilate  an  organ.  A  better  understanding  is  also  had  of 
percutaneous  medication.  Thus,  Short  and  Salisbury96, 
endeavor  to  show  by  scientific  investigations  that  applica- 
tions to  the  skin  (ointments,  lotions,  plasters),  are  abso- 
lutely without  value  as  determined  by  methods  of  testing 
the  cutaneous  sensations.  In  fact,  many  recognized 
local  anesthestics  applied  to  the  unbroken  skin  rarely 
produced  an  anesthesia.  In  view  of  the  author's  ob- 
servations, such  investigations  which  do  not  take  the 
visceral  reflexes  into  consideration  are  futile.  It  is  known 
that,  stimulation  of  the  respiratory  center  is  greater 
through  the  cutaneous  nerves  than  through  the  branches 
of  the  vagus  to  the  respiratory  organs. 

DIFFERENTIAL   DIAGNOSIS   OF  CHEST-PAIN. 

It  is  by  no  means  always  easy  to  differentiate  the  pains  of 
angina  pectoris  from  other  chest-pains,  insomuch  as  there 
are  many  grades  of  true  angina.  Two  factors  make  up  a 
typic  anginal  paroxysm:  pain  (dolor  pectoris),  located  in 
the  sternum  and  radiating  to  the  arm  (usually  the  left),  and 
a  feeling  of  anguish  and  sense  of  imminent  dissolution  (angor 
animi).  Among  other  typic  signs  are:  increased  blood- 
pressure,  sensory  areas  of  the  skin  (Figs.  23  and  24),  and  the 
relief  of  the  paroxysms  by  amyl  nitrite  (page  226),  or  other 
vasodilators. 

Chest-pain  may  be  caused  by  diseases  of  the  heart, 
pericardium  and  vessels,  pleura,  lungs  and  bronchi,  media- 
stinum, esophagus,  intrathoracic  nerves  and  nerves  of  the 
chest- wall,  bones,  joints  and  periosteum,  mammary  glands, 

545 


Spondylotherapy 

skin  and  muscles.  Space  will  not  permit  me  to  discuss  all 
these  varieties  of  pain. 

INTERCOSTAL  NEURALGIA. — Fully  95  per  cent,  (analysis 
by  author  of  1,000  cases),  of  all  cases  of  chest-pain  are  caused 
by  intercostal  neuralgia  (Chapter  VI),  and  the  immediate 
relief  by  paravertebral  freezing  constitutes  one  of  the  most 
brilliant  triumphs  of  therapeutic  medicine.*  This  form  of 
neuralgia  is  observed  more  often  on  the  left  than  on  the  right 
side,  owing,  as  Henle  supposed,  to  the  fact  that  the  veins  on 
the  right  side  pour  their  blood  into  the  great  veins  by  a  less 
circuitous  route. 

Occasionally  one  finds  intercostal  pains  secondary  to 
intrathoracic  tumors,  aneurysms,  diseases  of  the  spinal  cord 
and  its  membranes  and  skeletal  mal-alignment  (foot-note, 
page  1 86  and  page  123). 

Pains  simulating  intercostal  neuralgia  may  be  one  of  the 
frontier  symptoms  of  gastric  cancer  and  are  caused  by  infil- 
tration of  the  paravertebral  tissues. 

In  the  foregoing  instances,  freezing  is  negatively  diag- 
nostic, insomuch  as  it  affords  no  relief. 

According  to  Wolfs  Law,  which  is  generally  accepted, 
every  change  in  the  form  and  function  of  the  bones,  or  of 
their  function  alone,  eventuates  in  definite  changes  in 
their  internal  and  external  configuration  in  conformity 
with  the  laws  of  mathematics.  The  shape  of  a  bone  is 
caused  by  the  function  it  performs.  In  this  sense, 
skeletal  mal-alignment  may  be  produced  by  improper 
static  conditions.  Intercostal  and  other  neuralgias 
(notably,  sciatica)  may  be  caused  by  changes  in  verte- 

*For  the  relief  of  pain  in  the  intervals  of  freezing,  the  author  employs  the  following 
efficient  analgesic  formula  for  a  single  dose,  which  may  be  repeated  if  necessary: 
Caffein,  grains,  2;  pyramidon,  grains,  5;  phenacetin,  grains,  5;  sodium  bicar- 
bonate, grains,  10;  sodium  bromid,  grains,  20.  Owing  to  their  deliquescence 
the  powders  are  dispensed  in  homeopathic  vials. 

546 


Intercostal     Neuralgia 

bral  alignment  alone.  As  a  rule,  in  such  instances, 
sciatica  is  secondary  to  lesions  of  the  sacro-iliac  joints 
(page  in),  for,  when  there  is  any  restriction  in  the 
movements  of  the  vertebral  column,  there  is  either  an 
increase  in  motion  in  the  sacro-iliac  joints  or  there  is  a 
change  in  the  inclination  of  the  pelvis. 

Mai-alignment  of  the  vertebrae  of  static  or  muscular 
origin  (page  123)  will  exert  pressure  on  the  spinal  nerves 
at  their  exit  from  the  intervertebral  foramina. 

This  can  be  easily  demonstrated  on  a  cadaver  or  by 
the  insertion  of  cylinders  of  wax  in  the  foramina.  Such 
pressure  is  equivalent  to  stimulation,  notably  if  there  is 
any  anomaly  of  the  spinal  nerves. 

Weir-Mitchell  has  demonstrated  that  a  nerve  subjected 
to  a  thermic  insult  becomes  swollen,  congested  and 
hemorrhages  occur  in  the  nerve. 

On  page  123,  reference  is  made  to  albuminuria  caused 
by  lordosis. 

My  investigations  show  that,  albuminuria  is  really 
caused  by  traction  or  pressure  on  the  lumbar  nerves. 
If  one  makes  continuous  pressure  on  either  side  of  the 
second  lumbar  spine  for  about  three  minutes,  one  may 
even  in  the  norm  detect  the  presence  of  traces  of  albumin 
in  the  urine  by  aid  of  Tanret's  reagent. 

About  fifteen  minutes  Faradization  of  this  region  will 
as  a  rule,  effect  the  same  object  and  when  the  urine  al- 
ready shows  albumin  as  in  nephritis,  its  quantity  is  very 
much  increased. 

When  the  pains  implicate  an  extremity,  it  is  important 
to  differentiate  radicular  pains  from  pains  of  a  nerve 
trunk. 

Here,  the  essential  point  in  differential  diagnosis^is  in 
the  distribution  of  the  hypoesthesia  or  anesthesia  as  de- 
termined by  the  objective  examination.  A  nerve-trunk 
represents  a  combination  of  an  anterior  motor  and  a 
posterior  sensory  root,  and  the  latter  in  their  intraspinal 
course  are  in  relation  with  the  dura  mater  and  the  verte- 
brae. If  a  lesion  involves  the  sensory  root  within  the 

547 


Spondyloth     e     r    a    p    y 

column,  the  sensory  disturbance  ensuing  will  have  a 
radicular  distribution. 

In  affections  of  a  peripheral  nerve-trunk,  the  sensory 
disturbance  is  distributed  irregularly  in  a  longitudinal 
or  oblique  direction  whereas  when  the  root  of  the  nerve 
is  involved,  the  hypoesthesia  or  anesthesia  represents  a 
regular  longitudinal  distribution  parallel  with  the  axis 
of  the  limb. 

Freezing  aids  in  differentiating  pains  of  peripheral  and 
central  origin  (page  188)  or  the  peripheral  nerve-trunk 
may  be  blocked.  Thus  in  sciatica,  a  perineural  injection 
into  the  nerve  may  be  made  with  50  cc.  of  normal  salt 
solution  containing  one  grain  of  beta-eucain.  The  in- 
jection is  made  at  the  gluteal  fold,  midway  between  the 
tuberosity  of  the  ischium  and  the  great  trochanter.  The 
needle  should  be  about  3  inches  in  length  and  should  be 
directed  upward  and  slightly  inward.  When  the  nerve 
is  reached  by  the  needle,  there  is  a  slight  twitching  of  the 
leg.  This  injection  is  curative  as  well  as  diagnostic. 

The  following  case  of  a  physician  is  cited  to  illustrate 
a  sensory  phenomenon,  which  I  have  frequently  noted, 
when  there  are  several  sources  in  the  excitation  of  pain. 

For  about  five  years,  the  patient  suffered  from  agoniz- 
ing paroxysmal  pains  radiating  from  the  precordium  to 
the  neck  and  left  arm.  The  attacks  were  associated  with 
a  sense  of  suffocation,  pressure  in  the  chest  and  perspira- 
tion. Several  physicians  had  concurred  in  the  diagnosis 
of  true  angina  pectoris.  Examination  demonstrated  a 
cervico-brachial  neuralgia  (pseudo-angina,  page  194). 
Freezing  of  the  sensitive  paravertebral  areas  brought 
immediate  relief  and  cure  after  six  seances.  At  each 
successive  seance,  new  points  of  paravertebral  tenderness 
developed  and  new  areas  in  the  distribution  of  pain  (the 
former  paravertebral  areas  of  tenderness  and  areas  of 
pain  having  disappeared). 

The  areas  were  no  doubt  present  at  the  primary  ex- 
amination but  they  were  overwhelmed  by  the  more  in- 
tense areas  elsewhere.  This  is  in  accordance  with  the 

548 


Phrenic        Nerve 

Law  of  Weber:  Sensations  increase  as  the  logarithm  of 
the  stimuli.  Thus,  a  candle  light  will  increase  the  illum- 
ination in  a  dimly-lighted  cellar,  but  the  light  would  not 
be  in  evidence  in  the  bright  sunshine.  This  phenomenon 
from  another  view-point  is  in  accordance  with  the  physi- 
ologic dictum  that  "any  center  mediating  a  definite  reflex 
suffers  a  loss  in  excitability  whenever  it  is  acted  upon 
at  the  same  time  by  any  other  pathway  not  concerned  in 
that  particular  reflex." 

PHRENIC  NERVE. — Among  the  intrathoracic  nerves  this 
nerve  may  be  implicated  in  a  veritable  neuralgia.  The 
phrenic  nerve  is  distributed  to  the  pleura,  pericardium  and 
diaphragm,  and  after  piercing  the  latter  it  supplies  the 
capsule  of  the  liver,  spleen  and  gall-ducts.  This  nerve 
springs  chiefly  from  the  fourth  cervical  nerve,  although  it 
usually  receives  a  twig  from  the  third  and  fifth  cervical 
nerves.  Referring  to  Fig.  10,  it  will  be  noted  that  its  chief 
source  of  origin  corresponds  to  the  fourth  cervical  segment. 
We  note  further,  that  its  exit  corresponds  to  the  second  and 
third  cervical  spines.  In  pleurisy  and  pericarditis  I  have 
almost  invariably  found  points  of  tenderness  corresponding 
to  the  latter  spines,  and  by  freezing  the  areas  of  tenderness, 
I  have  not  only  inhibited,  but  arrested  the  pains  of  these 
affections.  In  a  diagnostic  sense  the  maneuver  is  equally 
valuable,  although  one  must  reckon  on  possible  implication 
of  the  capsule  of  the  liver,  spleen  and  gall-ducts,  likewise 
innervated  by  this  nerve. 

In  pleural  pains,  I  have  noted  dermatomes  connected 
with  the  fourth  cervical  segment  (Figs.  23  and  24). 

It  is  known  that,  when  pain  is  associated  with  pul- 
monary disease,  it  is  usually  caused  by  pleural  involve- 
ment. 

In  pneumonia  and  pleurisy,  the  chief  pain  is  located  in 
the  abdomen.  Here,  the  reflex  pain  is  probably  med- 

549 


Spondyloth     e    r    a    p    y 

iated  by  the  phrenic  nerve,  which  supplies  the  parietal 
peritoneum  (page  416).  In  involvement  of  the  struc- 
tures innervated  by  the  phrenic,  shoulder-pain  is  not 
infrequent.  The  skin  of  the  shoulder  is  supplied  by  the 
fourth  and  fifth  cervical  nerves,  hence,  the  reflex  dis- 
tribution of  pain  (Fig.  22). 

DIAPHRAGM  REFLEX. — When  intermittent  pressure  is 
made  between  the  second  and  third  cervical  spines,  a  slight 
protuberance  is  noted  on  one  or  both  sides  in  the  epigastrium 
under  the  costal  borders,  with  a  wave  running  between  the 
two  protuberances.  The  maneuver  is  executed  with  the 
patient  in  th'e  recumbent  posture,  knees  flexed,  head  toward 
the  window  and  at  the  end  of  expiration.  The  phenomenon 
is  specified  by  the  author  as  the  diaphragm  reflex.  It  is 
more  constant  than  the  phrenic  shadow  of  Litten.  It  is 
absent  in  diseases  of  the  phrenic  nerves  leading  to  spasm  or 
paralysis  of  the  diaphragm. 

ANEURYSM  OF  THE  AORTA. 

DEFINITION. — An  aneurysm  signifies,  literally,  a  dila- 
tation, but  there  are  nomenclators  who  insist  in  differen- 
tiating a  dilatation  from  an  aneurysm  of  the  aorta.  This, 
like  many  classifications  of  aneurysm,  is  essentially  an 
anatomic  and  not  a  clinical  question.  Clinically,  aortic 
dilatations  may  be  divided  into  two  groups,  dilatations  with- 
out (latent  cases),  and  with  symptoms.* 

Prior  to  my  recognition  of  the  aortic  reflexes,  several 
of  us  saw  a  patient  with  pains  radiating  to  the  left  arm 
and  chest  in  whom  the  X-rays  revealed  simple  aortic 

*Even  though  an  aortic  dilatation  is  demonstrable,  it  is  difficult  to  say  what  bearing 
it  may  have  on  the  symptoms.  The  diagnostic-therapeutic  test  by  daily  con- 
cussion of  the  7th  cervical  spine  may  be  necessary  for  a  decision.  Within  ten 
days,  if  aortectasis  is  related  to  the  symptoms,  the  latter  must  show  ameliora- 
tion. 

550 


Aneurysm      of     the      Aorta 

dilatation.  The  pains  were  sufficiently  severe  to  demand 
analgesics,  and  yielded  after  three  weeks  rest  in  bed. 

After  three  years,  the  pains  recurred  and  the  X-ray 
picture  was  identical  with  that  of  the  first  examination, 
yet  several  treatments  of  concussion  to  elicit  the  aortic 
reflex  of  contraction  sufficed  to  subdue  the  symptoms. 

Peripheral  pains  in  the  thorax  and  arms  simulating 
neuritis  without  the  symptoms  of  the  latter  (tenderness 
of  the  nerves  in  the  implicated  region,  motor  and  sensory 
disturbances),  suggest  an  aneurysm.  The  latter  fact  is 
illustrated  in  the  case  cited  on  page  575. 

To  escape  the  confusion  created  by  a  hybrid  anatomico- 
clinical  terminology,  a  compromise  may  be  effected  by  em- 
ploying the  term  dortectasis,  to  designate  aneurysm  or  dila- 
tation of  the  aorta.  Aneurysm  of  the  aorta  is  by  no  means 
as  infrequent  as  is  currently  supposed;  on  the  contrary,  the 
percentage  of  deaths  varies  from  0.6  per  cent,  of  total  mor- 
tality (Emmerich)  to  1.49  per  cent.  (Miiller). 

Death  occurs  suddenly,  as  a  rule,  owing  to  rupture  of 
the  sac,  and  many  cases  of  sudden  death  referred  to  other 
conditions,  owing  to  the  absence  of  an  autopsy,  are  often 
caused  by  an  aneurysm. 

Practically  three-fourths  of  all  aneurysms  are  aortic  and 
nineteen-twentieths  of  these  are  located  in  the  thoracic  aorta. 
Of  the  latter,  about  90  per  cent,  are  saccular;from  80  to  90 
per  cent,  occur  in  the  male,  and  about  50  per  cent,  occur 
between  the  ages  of  35  and  50. 

Respecting  the  etiology  of  aneurysms,  it  has  been  said 
that  the  victim  is  usually  one  who  has  worshiped  at  the 
shrine  of  Venus,  Bacchus  or  Vulcan.  In  etiology  most 
writers  ascribe  the  preponderating  role  to  syphilis.  The 
latter,  as  an  etiologic  factor  varies  in  percentage  from  25 
(Klemperer)  to  92  per  cent.  (Rasch).  Indeed,  Osier  affirms 
that  an  aneurysm  in  a  person  of  either  sex,  under  the  age  of 

551 


Spondyloth     e     r    a    p    y 

thirty,  is  presumptive  evidence  of  syphilis.  Among  my  own 
patients  (60),  a  syphilitic  history  was  positively  established 
in  only  20  per  cent,  of  the  cases. 

In  several  instances,  where  a  history  of  syphilis  was 
positive,  no  Wassermann  reaction  was  obtainable. 
Statistics  show  that  in  some  of  the  late  lesions  of  syphilis, 
a  reaction  may  be  elicited  in  only  50  per  cent,  of  the  cases. 
The  reaction  is  usually  positive  in  the  secondary  stage 
of  untreated  syphilis. 

Whether  the  reaction  is  positive  or  negative,  mercurial 
inunctions  are  nevertheless  indicated,  although  I  have 
never  observed  any  benefit  from  them  in  my  aneurysmal 
cases. 

MESAORTITIS. — This  is  a  peculiar  type  of  arterio- 
sclerosis associated  with  aortic  insufficiency  and  aneurysm, 
and  is  comparatively  frequent  in  syphilitics,  notably  in 
young  subjects. 

A  similar  lesion  is  found  in  congenital  syphilis.  Spi- 
rochetes  are  demonstrable  in  the  lesions. 

Evidence  is  accumulating  to  show  that  aortic  insuf- 
ficiency is  one  of  the  most  frequent  causes  of  syphilis,  and 
a  positive  Wassermann  reaction  may  be  elicited  in  a 
number  of  patients  thus  afflicted. 

The  Babinski  syndrome  (inequality  of  pupils  and  Ar- 
gyll-Robertson phenomena  with  aneurysm),  suggests 
syphilitic  infection  and  so  does  the  prompt  relief  afforded 
by  potassium  iodid,  as  suggested  by  Osier. 

Among  other  factors  contributory  to  the  etiology  are, 
overwork,  traumatism,  abuse  of  alcohol  and  the  infectious 
diseases. 

In  the  opinion  of  the  writer,  the  foregoing  factors  may 
operate  by  diminishing  vagus-tone.  In  accordance  with  this 
view-point,  the  anatomic  changes  in  the  aortic-wall  may 
be  secondary  to  the  primary  aortectasis.  In  young  persons 
the  most  important  etiologic  factors  are  trauma  and  endo- 

552 


Symptomato     logy 

carditis,  causing  the  so-called  embolomycotic  aneurysms.  In 
the  latter,  bacteria  are  found  in  the  aneurysm'al  wall  similar 
to  those  found  in  endocardial  vegetations. 

SYMPTOMATOLOGY. — Since  the  advent  of  the  X-rays  and 
exact  methods  of  percussion,  the  non-recognition  of  an 
aneurysm  is  an  unpardonable  error  in  diagnosis.  The  sub- 
jective symptoms  are  essentially  pressure-symptoms  and  vary 
with  the  degree  and  location  of  the  dilatation. 

Among  the  symptoms  may  be  mentioned: 

1.  Pain  in  the  sternum,  ribs  or  the  spine  from  direct 
pressure;  surrounding  the  upper-chest,  from  pressure  on  the 
intercostal  nerves;  radiating  down  the  side  of  the  chest  and 
the  inner  surface  of  the  arm,  from  pressure  on  fibers  dis- 
tributed by  the  intercosto-humeral  nerve. 

2.  Dyspnea. — Caused    by   irritation   of   the   recurrent 
nerve  (aphonia,  hoarseness  and  a  metallic  cough),  tracheal, 
bronchial  or  pulmonary  pressure.     Dyspnea  may  be  parox- 
ysmal and  suggests  asthma. 

3.  Cough. — A  frequent  early  sign,  of  a  peculiar  wheezy, 
brazen  or  metallic   character   ("goose-cough").     Cough   is 
caused  by  pressure  on  the  vagus,  recurrent  laryngeal  nerve, 
compression  of  the  trachea  or  a  main  bronchus.     Pressure 
on  either  of  the  two  latter  structures  is  associated  with 
stridor  and  expectoration.     Cough  and  dyspnea  are  out  of 
proportion  to  the  physical  signs.     The  symptoms  may  sug- 
gest phthisis  (aneurysmal  phthisis}. 

4.  Dysphagia. — Caused  by  spasm  or  stenosis  of  the 
esophagus. 

5.  Hemorrhage. — Caused  by  tracheal  granulations  at 
the  point  of  compression,  rupture  into  the  bronchial  tree  or 
from  erosion  or  perforation  of  the  lung.     Bleeding  may  be 
sudden,  profuse  and  fatal,  or  recurrent  for  months. 

6.  Emaciation. — From   pressure  on  the  thoracic  duct. 

553 


S  p 


o    n 


d 


y 


t  h 


r    a    p    y 


The  author  •  wishes  to  emphasize  the  fact  that  the 
symptoms  are  often  paroxysmal,  for  the  reason  that  the 
aorta  is  not  constant  in  caliber;  a  temporary  increase  of 
dilatation  may  precipitate  a  group  of  symptoms  which  dis- 
appear when  the  lumen  of  the  vessel  is  restored. 

Fig.  122  shows  the  relation  of  the  aorta  to  adjacent 
structures  and  is  explanatory  of  aneurysmal  symptomatology. 


CEsophagus 
•Vagus  nerve 
•Phrenic  nerve 

Vena  azygos  major 
Right  bronchus 

Right  pulmonary  artery 
Pulmonary  vein 


Thoracic  d 
Phrenic  ne 

Recurrent  laryngeal  ne 
Common  carotid  art 

Bronchial  arte 

Pulmonary  arte 
Left  vagus  nerv 

Left  bronchi 

Pulmonary  vei 
Aort 

Thoracic  due 
Vena  azygos  ma  jo 


FIG.  122. — Contents  of  the  mediastina  viewed  from  the  rear.  (From  Davis, 
applied  Anatomy,  J.  B.  Lippincott  Co.,  publishers). 

OBJECTIVE  SYMPTOMS. — i.  Percussion  shock. — Direct 
percussion  over  an  aneurysmal  area  elicits  a  shock  not  unlike 
that  felt  when  a  rubber- bag  filled  with  water  is  simultaneously 
palpated  and  percussed  (semi-fluctuation).  This  sign,  ori- 
ginal with  Smith,  was  detected  in  62  per  cent,  of  his  cases, 
whereas  the  tug,  to  be  described  presently,  was  present  in 
only  46  per  cent,  of  his  cases.  Grasping  the  cricoid  car- 
tilage for  eliciting  the  following  sign  (tugging)  while  an 
assistant  percusses  the  chest,  a  direct  and  resilient  shock  is 
felt  when  an  aneurysmal  area  is  reached.  Normal  chest- 
areas  reveal  to  the  fingers  at  the  cricoid  cartilage  only  a 
distant  feeble  jar. 

554 


Objective    S  y    m   p    to    m   s 

2.  Tracheal  tug. — This  sign  of    Oliver  is   as  follows: 
With  patient  standing  with  closed  mouth  and  elevated  chin, 
grasp  cricoid  cartilage  between  finger  and  thumb  and  lift  it. 
A  tug,  most  marked  in  inspiration  and  transmitted  to  the 
fingers,  is  supposed  to  be  diagnostic  of  aortectasis.    The 
latter  is  not  correct,  insomuch  as  it  is  found  in  conditions 
which  cause  adhesions  between  the  aorta  and  air-passages. 
It  is  not  infrequent  in  tuberculosis,  pleuritis,  mediastinal 
tumors,  enlarged  bronchial  glands  and  in  enteroptosis,  when 
the  heart  descends  with  the  liver,  and  the  arch  of  the  aorta  in 
this  way  makes  traction  upon  the  bronchi.     The  author  finds 
that  this  symptom  is  best  elicited  at  the  end  of  a  forced  inspir- 
ation. :.' 

3.  Inspection. — Dilatation  of  the  veins  of  the  neck, 
chest  and  arms.     Diffused  arterial  pulsations  of  the  carotids 
and  subclavians.     Pulsation  in  the  first  and  second  inter- 
spaces.    To  detect  latter,  patient  must  be  in  recumbent 
posture  in  a  good  light  and  the  observer's  eyes  should  be  on 
a  level  with  the  chest,  which  must  be  viewed  in  different 
directions.     Inspection  of  the  patient's  back  for  pulsations 
is  equally  important.     Swelling  and  edema  of  the  right  arm 
may  be  present  from  pressure  on  the  subclavian  vein  and, 
on  the  front  of  the  chest,  from  pressure  on  the  internal  mam- 
mary, azygos  or  hemiazygos  veins.     The  larynx  may  be 
pulled  downward  and  displaced  to  one  side. 

4.  Palpation. — In  some  cases,  the  aorta  can  be  palpated 
in  the  episternal  notch  and  a  lift  of  the  manubrium  can  be 
felt.     Over  the  dilatation,  one  may  feel  a  diastolic  shock  or 
a  systolic   thrill   or  both.     Differences  in  the  radial  pulse 
are  so  frequent,  even  in  the  norm,  that  little  importance 
can  be  attached  to  changes  in  the  radial   pulse   on  both 
sides. 

The  author  wishes  to  direct  attention  to  a  new  sign  in. 

555 


Spondylotherapy 

thoracic  aneurysms,  viz.,  extreme  sensitiveness  of  the  vagus 
to  palpation  on  one  or  the  other  side  of  the  neck. 

As  a  rule,  the  most  tender  points  are  located  where  the 
recurrent  laryngeal  nerve  enters  the  larynx  behind  the 
articulation  of  the  inferior  cornu  of  the  thyroid  cartilage  with 
the  cricoid,  and  at  a  point  between  the  hyoid  bone 
and  the  ala  of  the  thyroid  cartilage,  where  the  internal 
branch  of  the  superior  laryngeal  nerve  pierces  the  thyrohyoid 
membrane.  The  latter  is  the  sensory  nerve  for  the  interior 
of  the  larynx  and  trachea. 

An  absence  of  pulsation  in  the  femoral  arteries  may  be 
noted  in  abdominal  aneurysms,  due  to  the  fact,  as  Osier 
suggests,  that  the  sac  acts  as  a  reservoir,  annihilating  the 
ventricular  systole,  thus  converting  the  intermittent  into  a 
continuous  stream. 

5.  Auscultation. — Accentuation    of    the    second    aortic 
tone,  a  systolic  murmur  and  a  diastolic  murmur,  if  aortic 
insufficiency  accompanies  the  aortic  dilatation.    An  accen- 
tuated metallic  second  sound  over  the  sac  of  the  aneurysm. 
An  important  sign  is  either  the  disappearance  or  modifi- 
cation of  the  murmur,  if  present,  after  concussion-treatment 
of  the  seventh  cervical  spine  (page  525). 

Drummond  refers  to  a  systolic  murmur  heard  in  the 
trachea  or  at  the  open  mouth  of  the  patient.  Respiration 
may  be  feeble  or  absent  in  some  part  of  the  lung,  owing  to 
pressure  of  the  dilated  aorta  (vide  report  of  case  on  page  575). 

6.  Percussion. — This  is  one  of  the  most  important  signs 
if  executed   according  to   the  methods  suggested   by  the 
author.     Percussion  should  be  made  during  the  time  the 
chest  in  in  the  position  of  forced  expiration.    A  number  of 
measurements  made  by  the  author  show  that,  during  the 
latter  phase  of  respiration,  the  sagittal  diameter  of  the  chest 
approximates  the  arch  of  the  aorta  from  .3  to  1.6  cm.     After 

556 


Objective     Symptoms 

this  manner,  the  elicitation  of  substernal  dulness  is  facilitated 
(page  254).  Vibrosuppression  (page  80)  may  be  required. 
The  author  now  finds  that  the  elicitation  of  the  aortic  reflex 
of  dilatation  (page  255)  is  no  longer  necessary  when  the  arch 
is  to  be  delimited.  Here,  the  aim  was  to  accentuate  dulness 
of  the  aorta  by  increasing  its  caliber.  Either  of  the  two 
following  methods,  preferably  the  first,  may  be  employed. 


\     GREAT  VESSEL  AREA 


FIG.  123. — Normal  boundaries  of  the  heart  and  great  vessels.  The  nipples  in 
this  figure  are  too  far  away  from  the  median  line  (Butler's  Diagnostics  of  Internal 
Medicine). 

The  SUPRACARDIAC  VASCULAR  AREA  containing  the 
aorta  and  pulmonary  artery,  may  be  represented  by 
drawing  a  horizontal  line  across  the  base  of  the  heart 
(J  inch  below  the  upper  border  of  the  manubrium,  the 
so-called  episternal  notch),  and  two  vertical  lines  ex- 
tending on  either  side  of  the  sternum,  from  the  base  of  the 
heart  to  about  the  lower  border  of  the  ist  rib. 

The  ASCENDING  AORTA  lies  behind  the  sternum  be- 
tween the  third  left  chrondrosternal  junction  and  the 
second  right  costal  or  aortic  cartilage.  The  latter  point 

557 


Spondylotherapy 

represents  the  commencement  of  the  AORTIC  ARCH, 
which  runs  obliquely  upward  and  backward  toward  the 
4th  dorsal  vertebra,  where  it  continues  as  the  descending 
thoracic  aorta. 

The  highest  point  of  the  aortic  arch  in  the  median 
line  is  at  about  the  center  of  the  manubrium  (about  i 
inch  or  2.5  cm.  below  the  episternal  notch). 

The  PULMONARY  ARTERY  traverses  the  left  sternal 
border  under  the  2nd  intercostal  space  and  the  2nd  costal 
cartilage. 

The  arch  of  the  aorta  terminates  at  a  point  in  the  back 
to  the  left  of  the  third  dorsal  vertebra,  at  which  point  the 
bifurcation  of  the  trachea  occurs. 

VAGUS-TONE  METHOD. — The  aortic  tone  is  under  the 
influence  of  the  vagus,  and  when  the  latter  is  increased,  per- 
cussion of  the  thoracic  aorta  is  abetted.  During  percussion, 
pressure  may  be  made  at  the  yth  cervical  spine  by  an  assist- 
ant, or,  better,  still,  the  head  of  the  patient  is  placed  in  a 
position  of  forcible  extension  (page  228). 

I  must  again  emphasize  the  importance  of  palpatory 
percussion,  i.  e.,  to  determine  dulness  by  the  sense  of  resist- 
ance. In  other  words,  to  disregard  the  audible  quality  of 
the  percussion-sound. 

Direct  percussion  of  the  vertebral  spines  (3d  to  6th  dorsal 
spines)  may  reveal  the  dulness  of  an  aneurysm  (vide,  verte- 
bral concussion,  page  79). 

Fig.  124  shows  the  normal  percussion-zones  of  the  spine. 

POSTURAL  METHOD. — When  the  patient  stands  on  an  ele- 
vation (Fig.  125),  and  stoops  far  forward,  the  course  of  the 
aortic  arch  may  be  easily  denned  by  percussion.  In  both 
methods,  forcible  percussion  must  be  used.  The  measure- 
ments of  the  aorta  in  the  norm  have  been  described  on  page 

255- 

The  fact  that,  a  supposititious  area  of  dulness  due  to  an 

558 


D 


a 


m 


S 


n 


aneurysm  may  be  diminished  or  increased  in  area  by  the 
elicitation  of  the  aortic  reflexes,  may  be  utilized  in  diagnosis. 
DAM-SIGN. — By  this  new  phenomenon,  I  refer  to  an  in- 
crease in  the  area  of  aneurysmal  dulness  (of  the  thoracic  or 
abdominal  aorta),  when  the  legs  are  forcibly  flexed  on  the 
thighs  and  the  latter  on  the  abdomen.  Compression  of  the 
abdominal  aorta  or  an  india  rubber  tube  applied  after  the 


Dullness 
Cist  to  4th  D.). 


Ostial 
Resonance 
(sthtoizthD  ). 


Impaired 

Resonance 

(Lumbar). 


t  Tympany 
(Sacral.) 


FlG.  124. — Normal  percussion-zones  of  the  spine  (Kordnyi,  Da  Costa). 

method  of  Momburg  for  hemostasis  will  yield  the  same  re- 
sult. By  any  of  the  preceding  maneuvers,  the  blood  is 
increased  in  quantity  in  the  aneurysmal  sac  and  distends  it. 

Aside  from  the  latter  maneuvers  and  the  aortic  reflexes, 
the  area  of  aneurysmal  dulness  is  diminished  when  the  skin 
corresponding  to  the  latter  is  irritated  or  when  the  tone  of 
the  vagus  is  increased  by  the  method  shown  in  Fig.  65. 

During  the  period  of  forced  inspiration  the  diameter  of 

559 


S    p     o    n     d    y    I    o     t    h 


r    a   p    y 


an  aneurysm  is  increased  and  decreased  during  a  forced 
expiration.  During  the  former,  the  intrathoracic  blood- 
vessels are  filled,  and  during  expiration,  they  are  relatively 
empty  (aspiration  action  of  the  thorax). 


FIG.  125. — Illustrating  the  postural  method  of  determining  the  course  of  the 
thoracic  aorta  by  percussion. 

AUSCULTATORY  PERCUSSION. — Percussion  of  aneur- 
ysms,  as  well  as  the  solid  viscera,  may  be  facilitated  by 
two  methods  of  the  author  described  elsewhere98  in 
detail: 

i.  If,  during  percussion,  a  stethoscope  is  allowed  to 
hang  from  the  ears  of  the  physician  (no  part  of  the  instru- 
ment being  in  contact  with  the  chest  of  the  patient), 
nuances  in  the  percussion-sound,  unrecognizable  by  un- 
assisted audition,  are  demonstrable.  Here  the  stetho- 
scope is  employed  as  a  microphone. 

560 


Fluoroscopy    o  f  t  h  e    Aorta 

2.  By  employing  the  principle  of  transsonance.  With 
the  finger,  strike  directly  the  yth  cervical  spine,  and  while 
so  doing,  gradually  approach  the  site  of  aneurysmal 
dulness.  When  the  outer  boundary  of  the  latter  is  at- 
tained, the  transmitted  resonance  is  no  longer  in  evidence. 


FIG.  126. — Right  anterior  oblique  position.  A,  clear  area,  corresponding  to 
right  lung;  B,  shadow  of  vertebral  column;  C,  clear  middle  space;  D,  shadow  of 

normal  heart  and  aorta;  E,  clear  area  corresponding  to  left  lung.     ,  dilated 

aorta;  .  — ,  small  commencing  aneurysm,  — . — . — ,  upper  part,  larger  aneurysm; 
— . — . — ,  lower  part,  position  of  dilated  auricle. 

7.  FLUOROSCOPY  OF  THE  AORTA. — Radio-diagnosis  may 
be  achieved  by  fluoroscopy  and  skiagraphy.  In  the  former 
method,  which  we  will  alone  consider,  the  aorta  traversed 
by  the  rays  is  directly  examined  by  the  fluorescent  screen. 
With  a  large  screen  covered  with  glass  the  aorta  may  be  out- 
lined on  the  latter  by  means  of  a  pencil,  such  as  is  used  in 
writing  on  glass.  In  the  early  history  of  radio-diagnosis, 
thoracic  aneurysms  were  diagnosed  more  frequently  than  in 
the  present  state  of  our  advanced  knowledge.  Thus,  Sailer 
and  Pfahler,  have  demonstrated  that  tortuosity  of  the  aorta 

561 


S  p     o     n     d    y    I    o     t    h     e   ,r    a    p    y 

in  arteriosclerosis  strongly  suggests  aneurysm  on  fluoroscopic 
examination.  Many  errors  are  now  obviated  by  an  X-ray 
examination  in  the  right  anterior  oblique  position;  the  rays 
are  made  to  penetrate  the  chest  obliquely  at  an  angle  of  45 
degrees  from  behind  forward  and  from  left  to  right;  the 
screen  is  in  front  and  to  the  right  and  the  tube  behind  and  to 
the  left.  In  this  position,  the  aortic  shadow  with  parallel 
sides  is  observed  throughout  its  entire  length,  and  termi- 
nates in  a  rounded  extremity  at  a  point  corresponding  to  the 
level  of  the  sterno-clavicular  articulations  and  the  third 
dorsal  vertebra.  The  picture  presented  in  this  position  is 
illustrated  (Fig.  126)  after  Holzknecht. 

Reference  must  also  be  made  to  the  accompanying  illus- 
tration (Fig.  127).  No.  i  illustrates  the  normal  aorta  in  the 
antero-posterior  examination;  the  parallel  lines  show  the 
central  opacity,  and  the  part  shaded,  the  aorta,  which  ex- 
tends to  one  side  of  the  central  opacity.  In  No.  2  an  examina- 
tion of  the  normal  aorta,  conducted  in  the  right  anterior 
oblique  position,  shows  the  vertebral  shadow,  represented 
by  the  parallel  lines,  and  the  shaded  part,  the  aorta.  No.  3 
is  the  aorta  examined  in  the  ordinary  antero-posterior  posi- 
tion, and  the  supposition  would  be  that  an  aneurysmal  sac 
is  present,  but  if  the  patient  assumes  the  right  anterior  ob- 
lique position,  the  sac  is  no  longer  evident  (No.  4),  but  the 
aortic  shadow  is  broader  and  retains  its  parallel  borders, 
hence  aortic  dilatation  and  not  aneurysm  exists.  Nos.  5  and 
.6  illustrate  an  aneurysm,  and  7  and  8  a  small  aneurysm 
arising  from  the  under  surface  of  the  arch.  Note  that  in  Nos. 
7  and  8  there  is  nothing  in  the  pictures  to  indicate  that  an 
aneurysm  exists;  in  fact,  the  appearance  differs  in  no  wise 
from  the  normal  (Nos.  i  and  2).  In  all  examinations  for  a 
suspected  aneurysm  the  tube  should  be  placed  in  all  posi- 
tions. 

5b2 


Fluoroscopy    o  f  t  h  e    Aorta 

The  shadow  of  an  aneurysm  is  more  pronounced,  the 
greater  the  amount  of  organized  clot.  If  the  shadow  is 
situated  to  the  right  of  the  central  opacity  and  nearer  the 
front  than  the  back  of  the  chest,  the  ascending  aorta  is  in- 
volved ;  but  if  the  shadow  is  projected  to  the  left  and  nearer 


i  t  / 

I 


t  i 


t 


i 

i 


8 


FIG.    127. — Radioscopic  examination  of  the   aorta,   after  Holzknecht   (vide 
description  in  the  text). 


the  back  than  the  front,  the  descending  aorta  is  probably 
involved.  The  depth  of  the  aneurysmal  sac  from  the  surface 
may  be  approximately  determined  on  the  principle  that  the 
nearer  the  sac  is  to  the  surface,  the  more  defined  will  be  the 
outlines  and  the  less  intensified  the  shadow.  Hence,  in 
rotating  the  patient  and  examining  the  shadow  anteriorly 
and  posteriorly,  it  is  presumably  nearer  that  surface  where 

563 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

the  shadow  is  the  smaller  and  more  clearly  defined.  The 
course  of  the  aneurysm  during  treatment  may  be  followed 
if  at  the  primary  examination  a  record  is  made  by  means  of 
the  orthodiagraph.  Pulsations  of  a  shadow  argue  for  an 
aneurysm,  but  the  latter  does  not  always  show  pulsation; 
in  fact,  a  dilated  aorta  may  show  more  forcible  pulsations 
than  an  aneurysm.  When  pulsations  are  absent,  the  inhala- 
tion of  amyl  nitrite,  as  I  have  frequently  demonstrated,  will 
bring  them  into  existence.  Neoplasms  may  show  a  com- 
municated pulsation  from  the  heart  or  the  blood-vessels. 

In  the  usual  examination  with  the  tube  in  the  center 
behind  the  patient,  one  observes  only  the  bend  of  the  aorta 
projecting  to  the  left  of  the  sternum  beneath  the  clavicle, 
whereas  the  ascending  and  descending  portions  cannot  be 
seen.  In  dilatation  of  the  aorta,  the  shadow  extends  either 
to  the  right  or  left  of  the  sternum  or  both,  and  it  persists  be- 
tween pulsations.  In  neurotic  individuals  and  when  the 
aorta  is  dislocated  (a  condition  which  I  shall  call  aortoptosis) 
in  enteroptosis,  a  shadow  extending  beyond  the  ste~num 
may  suggest  aneurysm,  but  as  a  rule,  between  pulsations, 
the  shadow  recedes  behind  the  sternum.  In  aneurysms  of 
the  innominate,  there  is  a  clear  space  (with  a  narrow  shadow 
of  the  artery)  between  the  latter  and  the  aortic  shadow. 

In  differentiating  the  shadows  of  structures  (glands, 
tumors,  etc.)  from  aneurysms,  the  former  may  rotate  upon 
their  axes,  but  they  do  not  show  the  expansion  of  aneurysms 
during  systole  and  their  contraction  during  diastole.  An 
invaluable  aid  is  furnished  by  the  elicitation  of  the  aortic 
reflexes  during  the  fluoroscopic  examination  (vide  report 
of  case  on  page  575). 

I  have  found  that  an  aneurysm,  like  the  heart,  responds 
by  contracting  when  the  skin  over  the  aneurysm  is  irritated, 

564 


Aneurysm     of   the     Pulmonary    Artery 

hence  cutaneous  irritation  is  of  no  value  in  differentiating 
the  silhouette  of  the  heart  from  an  aneurysm. 

Among  other  signs  of  thoracic  aneurysm  may  be  men- 
tioned: inequality  of  the  pupils  (anisocoria)  due  to  pressure 
upon  the  sympathetic  or  alterations  in  the  circulation,  delay 
and  inequality  of  the  radial  pulses,  pain  and  persistent 
numbness  in  the  shoulder  and  arm,  signs  of  arteriosclerosis 
(thickening  of  the  palpable  arteries)  and  abatement  of 
symptoms  after  a  single  seance  of  concussion  applied  to  the 
seventh  cervical  spine. 


FIG.  128. — Percussion-areas  of  an  aneurysm  of  the  abdominal  aorta  seen  in 
consultation  with  Dr.  Visscher.  A,  area  of  aneurysmal  dullness  by  percussion; 
B  and  C,  aorta  reflexes  of  dilatation  and  contraction.  Reduced.  Compare  with 
Fig.  72. 

Broncho-esophagoscopy  may  show  tracheal  compression 
and  pulsation  or  a  pulsatile  tumor  implicating  the  esophageal 
wall. 

ANEURYSM  OF  THE  PULMONARY  ARTERY. — Aneurysms  of 

this  vessel  are  comparatively  very  rare.     The  symptoms 

(dyspnea,  cyanosis,  cough,  bloody  expectoration,  murmur 

n  second  left  inter-space,  etc.)  may  suggest  congenital  heart 

565 


Spondyloth     e    r    a    p    y 

disease.  An  X-ray  examination  furnishes  the  most  trust- 
worthy evidence,  although  the  affection  is  rarely  interpreted 
intra  vitam. 

ANEURYSM  OF  THE  ABDOMINAL  AORTA. — This  is  rela- 
tively frequent  (10-14  per  cent,  of  aneurysms),  and  trauma 
plays  an  important  role  in  etiology.  The  aneurysmal  sac  is 
located  most  often  just  below  the  diaphragm  in  juxtaposition 
to  the  celiac  axis. 


FIG.  129. — Apparatus  for  taking  tracings  of  the  abdominal  aorta.  The  pul- 
sations are  conveyed  by  a  cardiograph  to  a  registering  tambour. 

The  subjective  signs  are:  neuralgic  abdominal  pains 
radiating  in  every  possible  direction  and  suggesting  renal 
calculi,  gastric  ulcer  and  other  affections. 

The  objective  signs  are:  expansile  pulsation  of  an  epi- 
gastric tumor,  over  which  a  thrill  may  be  felt  or  a  systolic 
murmur  may  be  heard,  retardation  and  inequality  of  the 
femoral  pulses,  an  area  of  dulness  influenced  by  the  aortic 
reflexes  (Figs.  72,  73  and  128)  and  an  X-ray  examination. 
The  latter  may  be  made  with  the  fluoroscope  after  the 
patient  has  been  freely  purged  for  several  days  and  lim- 
ited to  a  diet  of  milk.  Inflation  of  the  colon  with  air  and 
the  use  of  a  "compression-diaphragm"  aid  the  fluoroscopic 
diagnosis. 

566 


Aneurysm  of  the  Abdominal  Aorta 

It  is  the  usual  practice  of  the  author  to  make  tracings 
of  the  abdominal  aorta  (aortograms)  as  aids  in  diagnosis. 
They  are  made  with  the  same  ease  as  sphygmograms  of 
the  radial  artery.  The  patient  is  placed  in  the  recumbent 
posture,  and,  at  the  end  of  a  forced  expiration,  during  the 
time  breathing  is  suspended,  the  cardiograph  is  placed 
over  the  abdominal  aorta.  The  apparatus  is  shown  in 
Fig.  129. 

A  \AA/WVWVV 


FIG.  130. — A,  normal  aortogram;  B,  aortogram  of  abdominal  arteriosclerosis; 
C,  aortogram  of  an  aneurysm  of  the  abdominal  aorta  (Fig.  128) 

The  course  of  the  abdominal  aorta  is  determined  by  a 
line  (aortic  line)  drawn  from  the  ensiform  cartilage  (to  the 
left  of  the  linea  alba)  to  the  level  of  the  highest  part  of 
the  iliac  crest.  At  the  latter  point  (f  inch  below  the 
navel),  the  aorta  divides  into  the  two  common  iliac 
arteries. 

The  CELIAC  Axis  is  located  on  the  aortic  line  about 
4  or  5  inches  (10  or  12.5  cm.)  above  the  navel. 

On  the  back,  the  aortic  orifice  in  the  diaphragm  cor- 
responds to  the  i  ath  dorsal  vertebra,  andtheceliac  axis 
to  the  lower  border  of  this  vertebra. 

ABDOMINAL  ARTERIOSCLEROSIS. — Paroxysmal  pains  due 
to  this  affection  are  diagnosed  with  difficulty  by  the  conven- 
tional methods  (page  266).  Here,  pathognomonic  aorto- 
grams may  be  taken. 

567 


Spondyloth     e    r    a    p    y 

I  have  noted  that  when  the  cardiograph  compressed  the 
abdominal  aorta,  some  of  the  abdominal  arteriosclerotics 
suffered  from  their  characteristic  pains. 

What  I  did  by  the  latter  maneuver  was  to  produce  an 
ischemia,  thus  accounting  for  the  phenomenon  of  claudica- 
tion  (page  226).  Compression  of  the  abdominal  aorta  to 
obliteration  with  the  fingers  may  therefore  be  utilized  as  a 
new  objective  sign  of  abdominal  arteriosclerosis. 

In  enteroptosis  with  loose  peritoneal  moorings  of  the 
aorta  (aortoptosis),  in  neurasthenic  women  and  in  arterio- 
sclerosis of  the  abdominal  aorta,  a  "throbbing  aorta"  may 
suggest  aneurysm  of  the  vessel.  Here,  there  is  no  definite 
tumor  and  no  expansile  pulsation.  Tumors  in  the  abdomen 
may  show  a  communicated  aortic  pulsation,  but  the  latter 
usually  disappears  in  the  knee-elbow  position. 

TREATMENT   OF   ANEURYSMS. 

Nothing  can  be  added  to  the  method  of  cure  suggested 
on  page  257  et  seq. 

The  author  has  reported  in  The  British  Medical  Jour- 
nal (July  8,  1911),  and  in  La  Presse  Medicate  (Oct.  4, 
1911),  forty  cases  in  his  own  practice  of  thoracic  and  abdom- 
inal aneurysms  which  were  symptomatically  cured  within 
a  few  weeks  by  the  concussion-treatment  with  absolutely  no 
other  adjuvant  measures  (not  even  rest). 

Since  then,  seven  other  cases  were  treated  with  the  same 
results. 

The  cases  were  all  advanced  and  there  was  absolutely  no 
break  in  the  continuity  of  successful  results. 

Some  of  the  author's  cases  were  seen  after  four  years  with 
absolutely  no  recurrence  of  symptoms. 

It  is  only  just  that  I  should  advert  to  several  patients  in 
whom  minor  symptoms  (a  slight  cough,  dyspnea  on  exertion 

568 


Treatment    of    Aneurysms 

and  an  inability  to  assume  the  recumbent  posture)  per- 
sisted. 

"Nothing  ever  gets  quite  well."  The  author's  treatment 
of  aneurysm  does  not  and  cannot  eliminate  the  aneurysmal 
sac,  although  it  is  somewhat  reduced  in  dimensions. 

It  is  impossible  to  conceive  of  a  large  intrathoracic  in- 
tumescence without  some  mechanic  disturbances  incident 
thereto. 

For  the  latter  reason,  the  author  advisedly  refers  to  his 
results  as  "symptomatic  cures." 

Failures  by  others  to  elicit  results  could  always  be  at- 
tributed to  mistreatment  (page  473). 

The  incurability  of  aortic  aneurysms  has  been  for  eons 
such  an  id£e  fxe,  that  it  has  graduated  into  an  obsess- 
ion. 

Probably  the  most  brilliant  achievement  of  Spondylo- 
therapy  consists  in  the  diagnosis  and  cure  of  aortic  aneurysms. 
Most  men  will  agree  that  the  cure  of  aneurysms  should  be 
considered  one  of  the  greatest  contributions  ever  made  to 
scientific  medicine.  But  such  is  the  cautiousness  of  medical 
minds  that  few  reviewers  of  Spondylotherapy  have  had  the 
faith  or  the  courage  to  speak  of  this,  its  greatest  achievement. 
Yet,  nothing  in  medicine  is  now  more  completely  proven, 
and  nothing  can  be  more  easily  demonstrated,  than  that 
Spondylotherapy  can  and  does  cure  this  heretofore  incurable 
disease. 

The  treatment  in  question  is  practically  a  specific.  I 
have  the  reports  of  12  cases  (in  addition  to  my  own),  from 
other  physicians  whose  results  practically  tally  with  my  own, 
despite  the  fact  that  only  primitive  apparatus  was  employed 
in  the  elicitation  of  the  aortic  reflex  of  contraction.  The 
following  case,  reported  "  by  Dr.  L.  St.  John  Hely,  of  Madera, 
California,  is  cited  for  the  following  reasons :  the  disease  was 

569 


S  p     o    n    d    y    I    o    t    h     e    r    a    p    y 

very  advanced,  the  relief  was  practically  immediate  and  the 
primitive  method  shown  in  Fig,  2  was  used. 

This  same  patient  was  seen  after  eighteen  months  about 
whom  Dr.  Hely  reports  as  follows: 

"I  am  enclosing  you  three  photographs  of  the  patient 
John  Artmann,  whose  case  was  treated  18  months  ago.  He 
came  into  my  office  yesterday  and  his  condition  is  absolutely 
normal.  It  was  so  wonderful  that  I  got  out  my  camera  and 
made  these  pictures.  There  are  no  pulsations,  nor  feelings 
of  pulsations  at  all  in  the  tumor  and  holding  the  hand  on  the 
tumor  after  climbing  the  stairs  conveys  no  suggestion  what- 
ever of  pulsations.  Facies  normal." 

Dr.  Hely,  reported  another  case  with  "the  same  brilliant 
results." 

Report  of  Dr.  Hely: 

"The  writer  presents  the  following  history  of  a  patient 
suffering  from  aneurysm  of  the  thoracic  aorta  who  was 
treated  by  the  'concussion-method'  of  Abrams: 

"J.  A.,  age  46  years;  weight,  185  pounds;  a  blacksmith 
and  a  moderate  drinker;  had  no  previous  history  of  illness 
beyond  the  diseases  of  childhood.  On  the  sixth  of  No- 
vember, 1909,  the  patient  first  noticed  a  small  projection 
in  the  region  of  the  first  rib  about  the  size  of  a  dime.  A 
peculiar  burning  sensation  corresponding  to  the  latter 
point  was  likewise  noted,  but  the  patient  gave  it  no  serious 
consideration  until  December  19  of  that  year,  when 
while  assisting  in  lifting  a  wagon  he  experienced  a  chok- 
ing feeling  and  the  miniature  projection  attained  an  enor- 
mous size.  The  patient  then  sought  medical  counsel  and 
the  diagnosis  of  a  thoracic  aneurysm  was  definitely  estab- 
lished. At  this  time  the  following  subjective  and  objec- 
tive symptoms  were  noted: 

"Pronounced  cyanosis  which  was  universal,  cardiac 
palpitation,  choking,  and  dyspnea  upon  the  slightest 
exertion,  and  an  almost  incessant  cough.  At  night  the 
patient  could  find  a  modicum  of  relief  only  in  one  posi- 

570 


Treatment    of    Aneurysms 


tion,  viz.,  propped  at  an  angle  of  45°  on  the  right  side, 
and  even  then  the  coughing  and  choking  would  awaken 
him  every  hour.  I  regarded  his  condition  as  absolutely 
hopeless  and  so  informed  his  friends.  Having  at  this 
time  read  of  the  method  of  Abrams,  I  employed  it  first 
on  January  21,  1910.  Concussion  treatment  of  the 
seventh  cervical  vertebral  spine  was  executed  daily  for 


FIG.  131. — Showing  external  tumor  in  Dr.  L.  St.  John  Hely's  case  of  aneurysm 
of  the  thoracic  aorta. 


fifteen  minutes  from  the  latter  date  until  March  5,  1910, 
when  treatment  was  discontinued. 

"The  second  night  following  the  concussion  the  patient 
rested  well,  and  after  the  fourth  treatment  there  was  an 
absolute  evanescence  of  all  symptoms.  In  the  language  of 
the  patient,  "I  can  now  sleep  in  any  position  and  like  a 
baby;  in  fact,  as  natural  as  any  one.  I  do  not  cough  nor 
suffocate  any  more,  and,  aside  from  the  tumor  on  the 

571 


Spondyloth     e     r    a    p 

chest,  I  would  not  know  that  there  was  anything  at  all 
the  matter  with  me." 

"The  aneurysmal  tumor  when  first  examined  projected 
considerably  and  measured  about  2\  inches  in  diameter 
at  the  base.  At  the  end  of  the  first  week's  treatment  the 
tumor  was  reduced  about  25  per  cent,  but  there  was  no 
apparent  further  diminution  in  size  when  treatment  was 
discontinued.  It  was  impossible  for  me  to  continue 
treatment,  as  the  patient  insisted  that  he  was  well  and 
further  treatment  was  unnecessary.  The  results  in  this 
case  were,  however,  immediate  and  corresponded  in  the 
main  with  the  results  obtained  in  the  cases  reported  by 
Dr.  Abrams." 

Two  other  reported  cures  were  made  by  Dr.  L.  C. 
Boyd  of  Long  Beach  (New  York  Medical  Journal,  Oct. 
21,  191 1)  and  Dr.  M.  L.  Turnbull,  of  San  Francisco 
(Medical  Record,  Sept.  9,  1911). 

Dr.  L.  C.  Boyd  reports  as  follows: 

"In  the  British  Medical  Journal  (July  8,  1911),  Dr. 
Albert  Abrams,  of  San  Francisco,  reports  forty  cases  of 
aneurysm  of  the  thoracic  and  abdominal  aorta  treated 
by  his  method  of  concussion  of  the  seventh  cervical  spine. 
His  method  is  practically  a  specific  in  a  disease  which 
has  heretofore  baffled  our  best  efforts,  and  it  creates  an 
epoch  in  therapeutic  medicine  and  elevates  physiologic 
therapeutics  to  a  place  of  distinction  in  the  armamenta- 
rium of  the  physician. 

"Mrs.  H.,  age,  31.  Duration  of  symptoms,  three 
years. 

"SUBJECTIVE  SYMPTOMS. — Precordial  pain,  radiating 
to  head  and  left  arm.  The  painful  paroxysms  were  accom- 
panied by  great  prostration.  Dyspnea  was  constant  and 
like  the  pain  was  accentuated  by  exertion,  emotions  or 
high  altitude. 

"There  was  a  troublesome  dysphagia,  insomnia  and 
dysphonia. 

"OBJECTIVE    SYMPTOMS. — Moderate    exophthalmos, 

572 


Subjective     Symptoms 

vascular  engorgement  of  face,  neck  and  hands  (notably 
on  the  left  side). 

"The  right  radial  pulse  was  retarded  and  weakened. 

"There  was  a  slight  bulging  of  the  anterior  chest-wall 
corresponding  to  the  first  and  second  intercostal  spaces  on 
the  left  side  and  a  marked  area  of  dulness  on  percussion. 

"The  latter  dulness  could  be  made  to  contract  or  en- 
large in  area  at  will  by  elicitation  of  the  aortic  reflexes. 
(This  is  an  important  diagnostic  aid  in  differentiating 
the  dulness  of  aneurysms  from  the  dulness  of  other 
causes.) 

"Palpation  yielded  a  slight  systolic  thrill  over  the  area 
of  aneurysmal  dulness. 

"A  loud  systolic  bruit  was  heard  over  the  aneurysmal 
dulness  which  was  propagated  posteriorly  along  the 
course  of  the  descending  aorta. 

"There  was  an  accentuated  second  aortic  tone. 

"The  heart  was  somewhat  displaced  to  the  left  and 
the  apex  beat  was  diffused  over  a  large  area  and  dimin- 
ished in  force. 

"Slight  tracheal  tugging  was  present. 

"Treatment  was  administered  twice  daily  and  com- 
menced on  July  2,  1911,  and  continued  until  the  iyth  of 
the  same  month. 

"The  following  notes  are  based  on  an  examination 
made  on  Aug.  8,  1911. 

"SUBJECTIVE  SYMPTOMS. — Absolutely  no  pains  of  any 
kind.  Dyspnea,  dysphagia  and  insomnia  have  disap- 
peared. The  voice  is  practically  restored  and  the  patient 
expresses  herself  as  being  highly  gratified  with  the  com- 
plete relief  from  previous  agonizing  physical  suffering 
which  this  treatment  has  afforded. 

"OBJECTIVE  SYMPTOMS. — No  exophthalmos  nor  vascu- 
lar engorgement  of  the  head  and  extremities. 

"Right  radial  pulse  no  longer  retarded  and  restored 
to  the  norm. 

"The  bulging  of  the  anterior  chest-wall  is  still  present, 
but  diminished. 

573 


S  p    o    n    d    y    I    o     t    h     e    r    a    p    y 

"The  former  aneurysmal  area  of  dulness  is  fairly  reso- 
nant but  not  completely  so.  The  latter  may  be  attributed 
to  the  induration  of  the  chest-wall  contiguous  to  the  site 
of  the  aneurysm. 

"There  is  no  longer  any  accentuation  of  the  second 
aortic  tone. 

"The  systolic  thrill  and  bruit  have  disappeared. 

"The  apex  beat  is  not  diffused  but  circumscribed  and 
has  regained  its  normal  position. 

"Tracheal  tugging  persists. 

"Improvement  in  strength  and  general  appearance  of 
well-being  still  continues. 

"There  was  no  X-ray  verification  of  the  conditions  in 
this  case,  but  the  physical  signs  respecting  the  aneurysm 
and  the  results  of  treatment  were  absolutely  positive  and 
unmistakable." 

Dr.  M.  L.  Turnbull,  presents  the  following: 

"The  report  of  the  following  patient,  I  believe  to  be 
indicated,  for  the  reason  that  we  have  heretofore  regarded 
aneurysms  of  the  aorta  among  the  incurable  diseases. 

"A.  D.,  age,  28  years.  Sent  to  California  by  his  phy- 
sicians in  Chicago  for  supposed  pulmonary  tuberculosis. 

"Seven  years  ago  contracted  syphilis.  Entered  the 
service  of  Dr.  W.  C.  Voorsanger,  at  the  Mount  Zion 
Hospital,  for  dyspnea,  pains  in  the  chest  and  a  constant 
cough  and  expectoration  which  permitted  him  no  sleep 
at  night  without  the  use  of  narcotics.  Slight  dysphonia. 
Veins  of  the  neck  very  prominent  and  dilated.  Slight 
tracheal  tugging. 

"Pronounced  dulness  on  percussion  of  the  upper  chest 
corresponding  to  the  arch  of  the  aorta,  which  measures 
6  cm.  in  diameter. 

"Systolic  murmur  over  aorta  propagated  toward  the 
left  shoulder. 

"Palpation  reveals  a  diastolic  shock  over  the  region 
corresponding  to  the  orifice  of  the  pulmonary  artery. 

"A  skiagraph  shows  an  immense  aneurysm  of  the 
thoracic  aorta,  chiefly  implicating  the  arch. 

574 


Comments     by     the     Author 

"Examination  of  the  sputa,  negative. 

"A  vigorous  course  of  inunctions  was  without  effect 
on  the  symptoms. 

"At  this  time  the  patient  presented  an  anemic  appear- 
ance and  his  weight  was  118  pounds. 

"Treatment  by  concussion  daily  of  the  yth  cervical 
spine  was  commenced  on  April  26,  1911.  After  the  first 
stance  of  concussion,  lasting  ten  minutes,  the  systolic 
murmur  over  the  aorta  almost  disappeared. 

"On  April  29,  the  aneurysmal  dulness  measures  trans- 
versely 2.6  cm. 

"May  i,  1911,  aneurysm  measures  2  cm.  and  the 
patient's  weight  is  123  pounds. 

"May  3,  1911,  absolutely  no  dulness  over  site  of  aneur- 
ysm, pains  in  chest  gone,  expectoration  reduced  about 
50  per  cent,  but  cough  continues  with  less  frequency 
and  severity. 

"July  i,  1911.  Patient's  weight  is  now  135  pounds. 
Has  absolutely  no  symptom  beyond  an  occasional  cough, 
which  may  be  attributed  to  a  naso-pharyngeal  catarrh." 

COMMENTS  BY  THE  AUTHOR. — On  Nov.  28,  1911,  this 
patient  developed  a  violent  cough  followed  by  hemo- 
ptysis. His  aneurysmal  symptoms  were  absolutely  gone, 
and  for  this  reason  search  was  made  for  his  trouble. 
An  apical  infiltration  was  demonstrated  with  a  large 
number  of  tubercle  bacilli  in  his  sputum.  Previous  ex- 
aminations of  his  lungs  and  sputa  were  negative. 

The  following  anamnesis  is  extremely  interesting  in  illus- 
trating discordant  views  among  the  leading  medical  authorities, 
coupled  with  the  fact  that,  the  execution  of  a  simple  diag- 
nostic sign  would  have  clarified  a  bizarre  and  protean  clinical 
picture : 

A  prominent  attorney  suffered  for  several  months  in 
San  Francisco  from  periodic  paroxysms  of  coughing, 
which  were  so  violent  as  to  induce  attacks  of  vertigo, 
and  narcotics  were  administered  to  subdue  them.  His 

575 


Spondyloth     e    r    a    p    y 

physicians  were  unable  to  trace  the  genesis  of  the  cough, 
and  receiving  no  relief,  he  left  for  Europe  for  further 
counsel.  During  his  sojourn  in  Europe,  he  suffered  from 
atrocious  pains  in  the  chest  and  the  left  arm.  Some 
ascribed  the  pains  to  neuritis,  although  there  was  abso- 
lutely no  objective  evidence  of  the  latter.  Repeated 
skiagrams  of  the  chest  demonstrated  the  presence  of  an 
intrathoracic  shadow  (Fig.  132),  the  nature  of  which  was 
variously  interpreted.  Kocher,  of  Bern,  after  deliberating 
a  week  concerning  his  findings  concluded  that,  the  pa- 
tient was  the  victim  of  a  spinal  growth  and  that  a  serious 
and  immediate  operation  was  necessary. 


FIG.   132. — Intrathoracic  shadow  of  an  aneurysm  interpreted   as  a  spinal 
growth  (vide  text). 

The  patient  almost  concluded  to  submit  to  an  opera- 
tion, but  before  so  doing,  he  consulted  Sahli  of  Bern. 
The  latter  assured  him  that  he  could  find  no  growth  and 
prescribed  quinin,  which  caused  the  pains  (which  had 
previously  resisted  narcotics)  to  evanesce. 

The  patient  was  subsequently  examined  by  at  least 
twelve  of  the  leading  authorities  of  Europe,  all  of  whom 
gave  varying  opinions.  On  the  return  of  the  patient  to 
this  city,  the  paroxysms  of  cough  continued  with  una- 
bated severity. 

My  examination  in  brief,  revealed  the  following: 

i.     Dilatation  of  the  arch  of  the  aorta  on  percussion; 

576 


Comments      by     the    Author 

2.  Slight  tracheal  tugging; 

3.  Induration  and  inflamation  of  the  vocal  cords  and 
a  slight  arytenoid  paralysis; 

4.  Absence  of  respiratory  sounds  over  the  lower  lobe 
of  the  right  lung; 

5.  On  fluoroscopic  examination,  a  shadow  was  seen, 
which  was  somewhat  fusiform  in  contour  and  approxi- 
mated the  spine. 

COMMENTS  BY  THE  AUTHOR. — The  possession  of  an  X-ray 
apparatus  does  no  more  in  postulating  a  knowledge  of 
skiascopy  than  the  possession  of  a  microscope  of  microscopy 
The  errors  perpetrated  by  the  microscopist  are  no  less  grave 
than  those  of  the  skiascopist.  The  proper  interpretation  of 
an  X-ray  ^examination,  coupled  with  correct  technic,  means 
essentially  a  study  of  chiaroscuro,  or  of  light  and  shadow 
effects.  An  X-ray  examination  is  practically  an  autopsy  con- 
ducted oh  the  living  and  misinterpretation  may  make  a 
verity  of  a  metaphor.  If  the  aortic  reflexes  had  been  elicited 
during  the  fluoroscopic  examination,  an  error  in  diagnosis 
would  have  been  practically  impossible,  insomuch  as  the  con- 
traction and  dilatation  of  the  shadow  would  have  demon- 
strated its  association  with  the  aorta. 

The  fact  that,  the  respiratory  sounds  over  the  lower  lobe 
of  the  right  lung  were  again  audible  after  a  brief  seance  of 
concussion  of  the  seventh  cervical  spine,  was  in  itself  a 
demonstration  that,  the  treatment  contracted  a  dilated  aorta 
and  thus  temporarily  eliminated  a  mechanic  bronchostenosis 
which  accounted  for  the  absent  vesicular  murmur. 

The  paroxysmal  symptoms  of  the  patient  suggested  an 
aneurysm,  insomuch  as  we  know  that  the  lumen  of  the  aorta 
is  not  constant  and  is  subjected  to  periodic  fluctuations  from 
a  variety  of  causes  (page  620). 

The  fact  that  the  pains  were  primarily  relieved  by  quinin, 

577 


Spondyloth     e    r    a    p    y 

only  emphasizes  the  importance  of  this  medicament  in  in- 
creasing vagus-tone  and  thus  diminishing  the  caliber  of  the 
aorta  which  by  pressure  caused  the  pains  from  which  the 
patient  suffered.  Two  weeks  daily  concussion  of  the  seventh 
cervical  spine  practically  subdued  the  violent  paroxysms  of 
coughing  and  the  larynx  was  almost  restored  to  normal. 

The  author  finds  that  fusiform  aortic  dilatations  are  less 
amenable  to  rapid  results  from  concussion  than  are  the  sac- 
cular  dilatations. 

Dr.  W.  T.  Baird,  a  prominent  physician  of  El  Pasor 
Texas,  presents  the  following  autobiography  of  his  case 
(reported  in  the  Medical  Record) : 

ANEURYSM  OF  THE  INNOMINATE  ARTERY. — "Dr.  W.  T. 
Baird.  Age,  almost  80  years.  Practiced  medicine  con- 
tinuously for  47  years,  during  8  years  of  which  time  I 
was  A.  A.  Surgeon  in  the  U.  S.  army.  Had  la  grippe  in 
1888,  and  since  this  time  have  suffered  from  cardiac 
arrhythmia.  During  the  last  5  years  I  have  experienced 
almost  constant  coldness  and  numbness  in  my  left  leg. 
About  one  year  ago,  pains  of  a  peculiar  sickening  and 
prostrating  character  were  experienced  in  the  arms  and 
chest  and  they  would  awaken  me  at  night.  About  three 
months  ago,  I  felt  a  pressure  on  my  trachea  which 
affected  my  voice  to  the  extent  of  aphonia.  Since  about 
one  year,  I  first  observed  a  diffused  pulsation  in  the 
supra-sternal  fossa.  My  pains  increasing  in  severity  and 
dyspnea  becoming  accentuated,  I  was  examined  by  Drs. 
Gallagher,  Brown,  Calnan  and  Fleming,  of  El  Paso,  all 
of  whom  concurred  in  the  diagnosis  of  an  aneurysm. 
I  then  decided  to  go  to  Dr.  Albert  Abrams,  of  San  Fran- 
cisco, for  treatment.  I  certainly  supposed  that  a  phy- 
sician who  had  originated  a  new  method  of  treatment 
for  an  incurable  disease  was  best  qualified  to  treat  it. 

"After  my  very  first  treatment,  a  troublesome  and 
persistent  cough  has  never  returned.  At  the  commence- 

578 


Aneurysm     of   the    Innominate    Artery 

ment  of  treatment,  my  voice,  which  was  then  only  a 
'squeak,'  was  rapidly  restored  to  normal. 

"After  twelve  treatments,  I  observed  the  following 
relative  to  my  condition:  cardiac  arrhythmia  has  dis- 
appeared, coldness  and  numbness  in  my  left  leg  are  no 
longer  present  and  the  pressure  on  my  trachea  and  the 
air-hunger  have  disappeared.  In  fact,  I  regard  myself 
as  perfectly  restored.  At  about  the  end  of  a  week,  the 
supra-sternal  pulsation  was  fully  reduced  50  per  cent." 

COMMENTS  BY  THE  AUTHOR. — My  examination  re- 
vealed dilatation  of  the  aorta,  but  the  arteria  innoffiinata 
was  chiefly  implicated  in  the  angiectasis. 

Painful  and  deformed  fingers  due  to  arthritis  deformans 
were  almost  restored  to  normal  after  twelve  treatments. 

The  results  thus  attained  are  given  explanation  on 
page  402. 

The  disappearance  of  arrhythmia  and  other  circula- 
tory disturbances,  can  be  attributed  to  myocardial-toning, 
insomuch  as  the  method  of  treatment  (concussion  of  the 
7th  cervical  spine),  evoked  equally  the  heart  and  aortic 
reflexes  of  contraction. 

Pains  in  the  arms  from  which  Dr.  Baird  has  suffered 
for  years  were  caused  by  an  osteo-arthritis  of  the  shoulder 
joints.  An  ankylosis  of  the  shoulder  is  not  uncommon 
and  the  adhesions  are  concealed  by  the  compensatory 
movement  of  the  scapula.  Any  elevation  of  the  arm  be- 
yond the  horizontal  in  the  norm  is  effected  by  rotation  of 
the  scapula,  hence,  in  testing  the  joint  fix  the  scapula. 
Aside  from  restricted  and  painful  motion  in  the  joint,  I 
have  found  that  the  sensitive  points  in  the  course  of  the 
brachial  plexus,  are  made  more  sensitive  by  active  and 
passive  movements.  In  inflammation  of  joints  limitation 
of  motion  is  also  due  to  rigid  muscles,  in  conformity  with 
the  law  of  Hilton: — nerves  innervating  groups  of  muscles 
moving  a  joint  also  furnish  a  distribution  of  nerves  to  the 
skin  over  the  insertions  of  the  same  muscles,  and  the  in- 
terior of  the  joint  receives  its  nerves  from  the  same  source. 

Even  an  imperceptible  ankylosis  may  show  acute  exacer- 

579 


8pondyloth     e    r    a    p    y 

bations  suggesting  neuritis,  but  the  absence  of  definite  areas 
of  tenderness  in  the  course  of  the  radiating  pains  excludes 
neuritis.  Here,  large  doses  of  the  salicylates  (page  142)  are 
effective. 

Dr.  Baird  noted  attacks  of  intense  dyspnea  after  riding 
in  his  automobile.  After  riding  in  larger  machines  such 
attacks  did  not  ensue.  The  back  of  his  seat  corresponded 
to. the  third  dorsal  spine,  which,  when  concussed  en- 
larges the  large  intrathoracic  blood-vessels 

ANEURYSM  OF  THE  THORACIC  AND  ABDOMINAL  AORTA 
IN  THE  SAME  SUBJECT.— A  gentlemen,  43  years  of  age, 
sought  relief  for  attacks  of  pain  in  the  chest  and  abdo- 
men. Intense  dyspnea  at  night  and  coughing  prevented 
sleep.  Lost  50  pounds  in  weight.  Examination  revealed 
in  brief  an  aneurysm  of  the  thoracic  and  abdominal 
aorta.  When  the  patient  first  came  under  observation  a 
chronic  parenchymatous  nephritis  was  demonstrated 
and  the  symptoms  (edema,  dyspnea)  becoming  accentu- 
ated, further  treatment  of  the  aneurysms  was  suspended. 

If  percussion  of  the  thoracic  aorta,  were  executed  as  a 
routine  method  of  examination,  a  clinical  in  lieu  of  an  an- 
atomical diagonosis  would  be  more  frequent  and  many 
apparently  trivial  symptoms  could  be  traced  to  their  real 
source  of  origin. 

Recently,  the  author  examined  an  individual  whose  only 
symptom  was  an  incessant  desire  to  swallow,  for  which  no 
relief  was  obtained.  Examination  demonstrated  an  aneur- 
ysm of  the  thoracic  aorta. 

•The  non-recognition  of  an  aneurysm  is  an  unpardonable 
error  in  diagnosis,  and  the  modernist  can  no  longer  seek 
refuge  for  his  dereliction  in  the  traditional  classification: 
(a)  Aneurysms  with  signs  and  symptoms,  (b)  Aneurysms 
with  symptoms  but  no  signs,  (c)  Aneurysms  with  neither 
symptoms,  nor  signs. 

580 


Rationale  of  the  Author's  Method 

RATIONALE  OF  THE  AUTHOR'S  METHOD. — This  is  essen- 
tially the  employment  of  a  reflex  in  treatment*  (page  392). 
The  author  believes  that  the  cure  of  aneurysm  by  his  method 
is  achieved  by  increasing  the  contractility  and  tonicity  of  the 
aorta  (page  410)  and  that  the  impulses  are  conveyed  indirectly 
to  the  vagus  (page  519  and  Fig.  119). 

Reduction  in  the  area  of  an  aneurysm  as  demonstrated 
by  numerous  skiagrams  is  never  in  proportion  to  the  amelior- 
ation of  the  subjective  symptoms. 

Percussion  may  show  an  absence  of  aneurysmal  dulness 
in  patients  symptomatically  cured,  yet  a  skiagram  reveals 
the  aneurysm  but  only  slightly  diminished  in  area. 

In  the  treatment  of  his  aneurysmal  cases,  .the  author 
employed  concussion  exclusively  as  a  crucial  test.  Having 
established  its  specificity,  he  no  longer  eschews  those  adju- 
vant measures  which  combat  aortectasis,  viz.,  inhibition  of 
cough  by  codein,  the  use  of  laxatives,  anti-luetic  treatment 
and  a  plenitude  of  physical  and  mental  rest.  The  influence 
of  the  latter  on  aortic  tonicity  has  been  shown  on  page  466. 
One  must  also  remember  that  an  hypodermatic  injection  of 
pilocarpin  (.0065  gm.),  will  accentuate  the  aortic  reflex  of 
contraction  (page  457).  One  may  also  advise  the  patient  to 
increase  vagus-tonicity  by  forcible  extension  of  the  head 
(page  469).  Such  exercises  maybe  taken  twice  a  day;  thirty 
extensions  suffice  for  each  seance. 

Fig.  133,  represents  the  primitive  apparatus  necessary  for 
concussion  in  the  absence  of  more  elaborate  apparatus. 
More  can  be  accomplished  with  an  ordinary  tack-hammer 
than  with  the  useless  apparatus  on  the  market.  In  fact,  with 
the  hammer  only,  cures  were  effected  by  other  physicians. 

*Dr.  H.  Jaworski,  of  Paris,  France,  designates  the  methods  of  the  author  as  verte- 
bral reflexotherapy.    Reflexotherapy  is  given  extended  consideration  on  page  636. 

581 


Spondylotherapy 

Due  regard  must  be  paid  to  the  possible  consequences 
when  concussion  is  executed  in  the  treatment  of  aneurysms 
(page  640). 

The  sinusoidal  current  may  substitute  concussion,  when 
the  stimulating  action  of  the  latter  is  exhausted  (page  400). 


FIG.  133. — Illustrating  primitive  apparatus  for  executing  concussion.  A  tack- 
hammer,  over  the  striking  end  of  which  is  affixed  the  rubber-tip  of  a  crutch  and  a 
piece  of  linoleum  or  other  suitable  material  over  the  end  of  which  a  piece  of  rubber- 
tubing  is  fitted  and  which  is  used  for  pleximetric  purposes. 

When  patients  are  hypersensitive  to  electricity,  the  author 
employs  rubber-cement  which  is  painted  on  the  skin  corres- 
ponding to  the  area  occupied  by  the  electrodes.  The  cement 
must  be  dry  before  using  the  current. 

COCAIN  KATAPHORESIS. — This  is  very  unsatisfactory, 
and  the  negative  results  suggest  a  very  important  field 
for  research.  In  my  investigations,  I  found  that  definite 
cutaneous  areas  rendered  anesthetic  by  cocain  (kata- 
phoretically  and  by  injection)  were  decidedly  more 
sensitive  to  electric  currents  than  were  normal  cutaneous 
areas.  In  hysterical  subjects,  the  author  has  found  that 

582 


o  c  a  i  n      Kataphoresis 

areas  of  anesthesia  peculiar  to  this  disease  react  similarly. 
There  is  much  reason  to  believe  that  nerve-energy  is  a 
form  of  electricity  and  in  man  there  are  electric  nerves. 
The  demonstration  of  animal  electricity  galvanometri- 
cally  is  difficult  of  demonstration,  but  the  foregoing  ob- 
servations may  suggest  a  new  field  of  observation,  i.  e., 
by  excluding  other  cutaneous  sensations,  the  perception 
of  electric  sensation  is  demonstrable.  After  this  manner, 
the  law  of  specific  nerve-energy  (page  545),  can  be  made 
manifest  with  reference  to  problematic  electric  nerves, 


S  p 


n 


y 


t    h 


a    p    y 


CHAPTER  XV. 

FURTHER  ADVANCES  IN  THE  DIAGNOSIS  OF  DISEASES  OF  THE 
DIGESTIVE   SYSTEM. 

PERCUSSION  OF  THE  STOMACH — DIAGNOSTIC  DATA — PERCUSSION  OF 
THE  INTESTINES — THE  GALL-BLADDER — DIAGNOSTIC  DATA — THE 
PANCREAS. 

PERCUSSION   OF  THE   STOMACH. 

Many  text-books  still  show  our  traditional  conception  of 
the  stomach  as  an  organ  horizontal  in  position,  with  the 
larger  curvature  as  a  deep  pouch,  and  the  pylorus  only  a 


FIG.  134. — Normal  stomach  of  Holzknecht  (illustration  to  the  left),  and  Rieder 
(illustration  to  the  right).    Vide  text  for  a  further  description. 

little  below  the  cardiac  orifice  (transpyloric  plane)  opposite 
the  first  lumbar  vertebra. 

With  the  advent  of  the  Roentgen  rays,  our  conception  of 
the  size  and  location  of  the  stomach  has  been  considerably 

584 


Percussion     o  f   t  h  e     Stomach 

modified  and  a  Roentgenographic  examination  (individual 
standing)  shows  the  normal  forms  of  the  stomach,  according 
to  Holzknecht  and  Rieder,  as  pictured  in  Fig.  134. 

In  the  former,  with  dorso-ventral  transillumination  in 
standing  and  the  stomach  filled  with  bismuth,  the  pylorus 
represents  the  most  dependent  part  of  the  stomach;  a,  cepha- 
lic pole;  b,  gas-bladder  of  the  pars  cardiaca  (fundus);  d, 
pars  media  (corpus);  e,  pars  pylorica;  c,  caudal  pole  (identi- 
cal with  the  pylorus).  The  stomach  is  the  shape  of  an  ox- 
horn. 


fundus 


Cardiat  orifice^ 
Les&ercutvatunt 


AnCrum, 
pylori 

FIG.  135. — Diagrammatic  outline  of  the  stomach  (Gray). 

On  page  321,  the  author  has  described  the  vago-visceral 
method  of  outlining  the  stomach  and  Fig.  86,  is  only  sche- 
matic. It  is  now  possible  to  delimit  by  percussion  practically 
the  entire  stomach  excepting  the  cardiac  orifice  (Fig.  135). 
The  latter  is  situated  at  a  point  on  the  yth  left  costal  cartilage, 
one  inch  (2.5  cm.)  from  the  sternum  and  corresponds  approx- 
imately with  the  body  of  the  nth  dorsal  vertebra.  Delimi- 
tation of  the  stomach  by  the  author's  method  of  percussion 
is  only  possible  with  the  patient  standing. 

During  the  time  the  gastric  walls  are  made  tense  by 
pressure  in  an  intercostal  space  by  an  assistant  (which 
causes  reflex  stimulation  of  the  vagus),  or  without  an  assis- 

585 


Spondyloth     e    r    a    p    y 

tant,  by  having  the  patient  fix  his  head  in  forcible  hyperex- 
tension,  as  shown  in  Fig.  65,  the  stomach  yields  a  dull  tone 
on  percussion.  The  intercostal  method  may  be  used  in 
children.  The  latter  dulness  at  once  becomes  tympanitic 
when  either  of  the  two  foregoing  maneuvers  are  inhibited. 

During  either  maneuver,  the  dulness  of  the  stomach  is 
differentiated  from  the  resonance  of  the  lung  and  the  tym- 
panicity  of  the  intestines. 

Fig.  136  represents  a  normal  stomach  outlined  by  the 
vago- visceral  method  of  percussion;  the  continuous  line 
represents  the  stomach  when  empty,  and  the  broken  lines 
the  position  after  the  ingestion  of  bismuth;  L,  represents  the 
lower  border  of  the  liver.  If  a  comparison  is  made  between 
the  X-ray  pictures  of  the  stomach  (Fig.  134)  and  those 
obtained  by  the  vago-visceral  method  of  percussion,  one 
notes  a  discrepancy  in  size  and  shape  of  the  organ. 

Now,  the  X-ray  pictures  have  been  determined  by  filling 
the  stomach  with  a  bismuth-paste.  We  note  in  Fig.  136, 
what  ensues  respecting  the  form  and  position  of  the  organ 
before  and  after  the  ingestion  of  bismuth,  and  we  are  con- 
strained to  conclude,  that  the  X-ray  pictures  are  artificial* 
and  only  partially  reproduce  the  real  shape  of  the  organ. 
The  moment  food  is  ingested,  and  particularly  bismuth,  the 
stomach  endeavors  to  evacuate  its  contents  and  the  exag- 
gerated vertical  posture  of  the  organ  is  manifested.  The 
latter  conclusion  was  only  formulated  after  repeated  exam- 
inations of  at  least  one  hundred  cases.  In  a  small  minority 
of  instances,  notably  in  severe  grades  of  gastric  atony  and 
gastroptosis,  the  vago-visceral  method  was  by  no  means 
easy,  owing  to  atony  of  the  musculature  of  the  stomach. 

*StiIler,101  likewise  protests  in  accepting  the  radiologist's  conception  of  the  shape 
of  the  normal  stomach,  which,  he  affirms,  is  only  the  specific  reaction  to  the 
ingested  bismuth. 

586 


Percussion    of   the     Stomach 

The  fact  that,  there  is  no  transition  from  tympany  to  dulness 
by  augmentation  of  vagus-tone,  may  be  utilized  in  estimating 
the  tone  of  the  muscular  component  of  the  stomach. 


FIG.  136. — Percussion  of  the  stomach  by  the  vago-visceral  method  (page  321). 
The  continuous  lines  represent  the  empty  stomach  and  the  interrupted  lines,  the 
contour  of  the  organ  after  the  ingestion  of  bismuth.  L,  indicates  the  lower  liver- 
border. 

Having  delimited  the  organ  by  percussion,  one  may 
easily  demonstrate  that,  concussion  of  the  5th  dorsal  spine 

587 


S  p    o    n    d    y    I    o     t    h     e    r    a    p    y 

or  paravertebral  pressure  (page  467),  will  enlarge  the  pylorus 
(dilatation)  and  that  similar  maneuvers  limited  to  the  3d 
dorsal  spine  will  contract  the  pylorus.  In  other  words,  we 
elicit  the  pyloric  reflexes  of  dilatation  and  contraction.* 

To  the  average  reader,  these  observations  seem  incred- 
ible, but  they  have  been  most  carefully  controlled  by  X-ray 
examinations  and  in  other  ways. 

The  following  simple  test  may  be  utilized  in  determining 
the  patency  of  the  pylorus;  after  careful  percussion  of  the 
upper  and  lower  border  of  the  stomach,  the  patient  ingests 
nine  ounces  of  water  and  the  time  is  noted  when  the  organ 
passes  from  the  vertical  to  its  normal  position.  As  a  rule, 
this  occurs  in  about  one  minute. 

Paravertebral  pressure  between  the  third  and  fourth  dor- 
sal spines,  which  inhibits  vagus-tone  (page  472),  will  maintain 
the  vertical  posture  of  the  stomach  as  long  as  pressure  is 
continued. 

DIAGNOSTIC  DATA. — Some  reference  to  this  subject  is 
made  on  page  323. 

In  several  instances,  the  writer  has  made  an  early  diag- 
nosis of  a  carcinoma  of  the  stomach  by  noting  irregularities 
of  the  borders  of  the  organ  after  percussion  of  the  latter. 
Gastrectasis  caused  by  pyloric  obstruction  may  be  deter- 
mined by  noting  the  absence  of  the  pyloric  reflexes.  That 
is  to  say,  percussion  by  the  vago-visceral  method  shows 
neither  an  augmented  area  of  the  pylorus  after  concussion 
or  pressure  at  the  fifth  dorsal  spine  nor  a  diminished  area, 
after  like  maneuvers  at  the  third  dorsal  spine. 

*My  measurements  show  that  the  location  of  the  pylorus  in  the  norm  is  8.6  cm.  from 
the  lower  border  of  the  costal  arch  in  the  parasternal  line.  It  has  a  normal 
width  by  percussion  of  1.6  cm.,  and  descends  2  cm.  after  a  deep  inspiration  or 
after  the  ingestion  of  9  ounces  of  water.  The  dilator  nerve  of  the  cardia  is  a 
closing  nerve  for  the  pylorus.  Opening  of  the  cardia  and  pyloric  contraction 
occur  simultaneously. 

588 


Cardiospa      s      m 

Perigastric  adhesions  may  be  surmised  when  percussion 
cf  the  stomach  shows  no  descent  of  the  latter  during  forced 
inspiration. 

An  hour-glass  stomach  was  determined  in  one  patient. 

Spasm  of  the  pylorus  may  be  differentiated  from  hyper- 
trophic  stenosis  by  elicitation  of  the  pyloric  reflexes. 

CARDIOSPASM  (contraction  of  the  cardiac  orifice)  is  usu- 
ally associated  with  esophageal  dilatation.  Regurgitation  of 
food  may  or  may  not  be  present.  The  food  regurgitated  is 
not  from  the  stomach.  Radiographs  show  the  dilatation  and 
esophagoscopic  examination  demonstrates  the  presence  or 
absence  of  pathologic  conditions.  In  cardiospasm  of  neu- 
rosal  origin,  pressure  between  the  third  and  fourth  dorsal 
spines  by  inhibiting  vagus-tone  (page  467),  will  enable  the 
patient  to  swallow  without  difficulty  during  maintenance  of 
pressure. 

In  cardiospasm,  the  stomach  tube  (30  to  35  French 
scale),  is  arrested  at  a  point  about  8  or  10  inches  from  the 
teeth.  In  any  obstruction  of  organic  origin  small  sounds  or 
tubes  will  pass  a  stenotic  orifice  more  easily  than  large  ones. 
The  contrary  holds  when  a  spasm  is  functional.  The  etiol- 
ogy of  cardiospasm  is  obscure.  A  few  cases  are  associated 
with  gross  lesions  (ulcers,  fissures)  of  the  esophagus  or 
stomach  (carcinoma)  and  neurasthenia  as  a  factor  in  etiology 
is  no  doubt  exaggerated. 

If,  during  the  passage  of  a  tube,  the  latter  is  obstructed 
owing  to  a  spasm  of  the  esophagus,  paravertebral  pressure 
between  the  3rd  and  4th  dorsal  spines,  by  releasing ,  the 
spasm,  permits  of  the  introduction  of  the  tube. 

Gastroptosis  may  be  differentiated  from  dilatation  of  the 
organ  by  noting  the  position  of  the  lesser  curvature  of  the 
organ  in  relation  to  the  greater  curvature.  In  gastroptosis, 
the  pylorus  and  lesser  curvature  are  correspondingly  de- 

589 


Spondyloth     e    r    a    p    y 

pressed,  whereas  in  gastrectasis,  it  is  the  greater  curvature 
which  is  displaced  downward.  By  the  author's  method  of 
percussion,  the  normal  distance  between  the  two  curvatures 
is  approximately  5  to  8  cm. 

Gall-bladder  disease  (cholelithiasis  and  cholecystitis), 
causes  adhesions  and  definite  displacement  of  the  stomach 
and  duodenum.  The  evidence  of  such  adhesions  has  been 
demonstrated  fluoroscopically  in  the  upright  position. 
Pfahler102  directs  attention  to  the  fact,  that  the  symptoms  of 
gall-bladder  disease  appear  during  digestion  when  adhesions 
interfere  with  the  emptying  of  the  gall-bladder,  either  di- 
rectly or  because  the  gall-duct  has  been  drawn  abnormally 
high. 

Vago-visceral  percussion  of  the  stomach  may  be  equally 
utilized  in  diagnosis  by  noting  the  approximation  of  the 
pyloric  end  of  the  stomach  to  the  gall-bladder.  It  is  also 
true  that  adhesions  would  prevent  the  vertical  posture  of 
the  stomach  after  the  ingestion  of  water  or  food. 

Pharmaco-diagnostic  data  with  relation  to  the  stomach 
have  been  noted  on  page  453,  and  it  is  well  to  bear  in  mind 
the  centers  in  the  cord  sensorially  related  to  the  stomach 
(page  377).  If  the  third,  fourth  and  fifth  dorsal  spines  are 
thoroughly  frozen,  all  subjective  and  objective  sensations  of 
gastric  genesis  evanesce  from  minutes  to  hours.  Thus,  one 
may  differentiate  gastric  from  other  affections.  Supple- 
mentary to  the  data  on  page  453,  my  observations  show 
that,  adrenalin  dilates  and  pilocarpin  contracts  the  stomach . 
Thus,  10  minutes  after  an  injection  of  pilocarpin  (gr.  iV), 
the  vertical  diameter  of  the  stomach  (lesser  to  greater 
curvature)  measured  2  cm.,  although  before,  it  measured 
5  cm.  Ten  minutes  after  an  injection  of  8  minims  of  adrena- 
lin chlorid  solution  (1:1000),  the  same  diameter  of  a  stomach 
increased  from  5 .6  cm.  to  9  cm.  After  this  manner  one  may 

590 


Percussion    of   the    Intestines 

determine  whether  gastric  neuroses  are  under  sympathetic 
or  autonomic  control. 

The  treatment  of  gastric  affections  has  been  discussed  on 
page  324.  Supplementary  to  treatment  referred  to  on  the 
latter  page,  a  comparison  of  concussion  and  slow  sinus- 
oidalization  is  shown  by  the  following  results:  the  duration 
of  concussion  and  sinusoidalization  of  the  second  lumbar 
spine  was  one  minute. 

CONCUSSION. 

Degree  of  stomach  reflex  of  contraction 2.8cm. 

Duration  of  stomach  reflex  of  contraction.... 5  minutes. 

SLOW  SINUSOIDAL  CURRENT. 

Amplitude  of  stomach  reflex  of  contraction 2  cm. 

Duration  of  stomach  reflex  of  contraction 1 1  minutes 

While  the  amplitude  of  the  reflex  was  less  with  the 
current,  its  duration  lasted  more  than  twice  the  time. 

PERCUSSION   OF   THE   INTESTINES. 

Physiologists  are  divided  concerning  intestinal  innerva- 
tion.  The  viscero-motor  nerves  are  derived  from  the  vagi 
and  sympathetic  chain. 

Clinical  physiology,  however,  sheds  some  light  on  the 
subject.  The  different  maneuvers  for  increasing  vagus-tone 
(page  469)  do  not  influence  the  intestinal  reflexes  (pages  325, 
326),  but  the  latter  cannot  be  elicited  if  the  vagus- tone  is 
removed  by  pressure  between  the  third  and  fourth  dorsal 
spines  (page  467). 

In  this  regard,  the  action  of  the  vagus  may  be  compared 
to  the  brain  and  cord.  Irritation  of  the  latter  has  no  evident 
effect  on  intestinal  movements  during  life,  yet  one  knows 
that  the  mentality  may  influence  the  movements  and  that  in 
paraplegia,  intestinal  motility  is  diminished  and  tympanites 
ensues. 

591 


Spondyloth    e    r    a    p    y 

The  elicitation  of  the  intestinal  reflex  of  contraction  (page 
325),  causes  a  contraction  of  all  the  intestines  and  it  is  im- 
possible to  differentiate  individual  portions. 

It  is  now  possible,  however,  to  elicit  dulness  of  definite 
intestinal  areas  by  aid  of  paravertebral  pressure  with  the 
radicularpressor  (Fig.  112).  Pressure  must  be  maintained 
by  an  assistant  during  the  time  percussion  is  executed  and 
the  patient  must  be  standing.  In  some  instances  the  area 
of  the  intestine  yields  an  absolute  dulness,  and  in  other 
instances  it  is  only  tympanitically  dull. 

The  following  pressure  sites  have  been  established: 

1.  DUODENUM. — Pressure  on  both  sides  of  the   loth 
dorsal  spine.    The  dulness  thus  elicited  averages  in  width 
4.5  cm.,  and  extends  an  average  distance  of  5.5  cm.  from 
the  pyloric  end  of  the  stomach.    Unlike  the  stomach,  it  is 
uninfluenced  by  the  movements  of  respiration,  and  the  site 
of  the  dulness  does  not  change  like  the  stomach  by  con- 
cussion of  the  nth  dorsal  or  2nd  lumbar  spines. 

2.  SIGMOID  FLEXURE. — Pressure  on  both  sides  of  the 
ist  dorsal  spine. 

3.  CECUM   WITH    ATTACHED    ILEUM  ?     AND  ASCENDING 

COLON. — Pressure  on  both  sides  of  the  i2th  dorsal  spine. 
Careful  percussion  demonstrates  an  area  of  dulness  attached 
to  the  cecum  averaging  2.5  cm.  in  width  and  3  cm.  in  length. 
This  is  possibly  a  part  of  the  ileum. 

4.  DESCENDING  COLON. — Pressure  on  both  sides  of  the 
ist  lumbar  spine.     The  average  area  of  dulness  is  small 
(6  cm.  x  6  cm.)  and  is  located  above  the  dulness  of  the  sig- 
moid  flexure  in  the  left  lumbar  region. 

5.  TRANSVERSE  COLON. — Pressure  on  both  sides  of  the 
4th  lumbar  spine     The  area  of  dulness  extends  across  the 
umbilical  region  from  the  ascending  to  the  descending  colon. 

592 


D 


a 


n 


Its  limitation  at  its  upper  part  is  not  always  clearly  denned. 
The  width  of  the  dulness  averages  4  cm. 


FIG.  137. — Areas  of  intestinal  dullness  elicited  by  paravertebral  pressure.  The 
dullness  of  the  stomach  (s)  was  determined  by  the  vago- visceral  method  (page  321), 
D,  duodenum;  C,  cecum;  I?,  probably  attached  ileum;  DC,  descending  colon;  SF. 
sigmoid  flexure;  TC,  transverse  colon,  the  continuity  of  which  is  interrupted  in  the 
illustration  by  the  stomach  and  duodenum.  Compare  with  Fig.  138. 

Fig.  137,  shows  the  location  of  the  areas  of  intestinal  dul- 
ness elicited  by  paravertebral  pressure  at  definite  spinous 
processes  and  Fig.  138,  shows  the  normal  topography  of  the 
intestines. 

593 


S   p    o    n    d    y    I    o    t    h    e    r    a   p   y 

DIAGNOSIS. — In  the  norm,  the  abdomen  is  (excepting 
hepatic  and  splenic  dulness)  tympanitic.  It  is  impossible 
with  the  conventional  methods  of  percussion  to  distinguish 


FIG.  138. — Normal  topography  of  the  alimentary  canal  (Rawlmg's  landmark8 
and  surface  markings  of  the  human  body),  i,  esophagus;  2,  stomach;  3,  pylorus; 
4,  4,  4,  the  three  parts  of  the  duodenum;  4  ,  the  pancreas;  5,  duodeno-jejunal  flexure; 
6,  mesenteric  attachment  of  small  intestine;  7,  ileo-cecal  valve;  8,  cecum;  9,  vermi- 
form appendix;  10,  ascending  colon;  n,  hepatic  flexure;  12,  splenic  flexure;  13, 
descending  colon;  14,  iliac  colon;  15,  ilio-pelvic  colon;  16,  gastro-hepatic  omentum; 
17,  foramen  of  Winslow;  18,  common  bile-duct.  Transverse  colon  omitted,  a,  a, 
and  a1,  a  — lateral  vertical  planes;  b,  b,  transpyloric  plane;  c,  c,  subcostal  plane; 
d,  d,  intertubercu\ar  plane. 

the  small  intestines  from  the  colon.  With  the  methods  sug- 
gested by  the  author  such  differentiation  is  usually  possible 
by  topographic  percussion. 

Intestinal  ptoses,  tumors,  dilatation  of  the  colon  and 
other  affections  may  be  differentiated  by  the  foregoing  meth- 
ods. 

594 


D         iagnosis 

Recently,103  attention  has  been  devoted  to  a  mobile, 
cecum  (coecum  mobile),  which  produces  symptoms  resem- 
bling appendicitis  and  at  the  operating  table  the  appendix 
was  normal.  The  value  of  topographic  percussion  in  such 
instances  is  apparent  without  comment. 

I  wish  to  illustrate  some  of  the  foregoing  methods  by  the 
citation  of  a  case  seen  with  Dr.  A.  Gates,  of  Los  Angeles. 

The  patient  has  lost  20  pounds  in  weight  during  the 
past  year.  Has  recurrent  attacks  of  pain  for  years  in  the 
epigastrium  of  a  dragging,  piercing  character,  several 
hours  after  food  is  taken,  which  is  relieved  by  the  ingestion 
of  more  food  or  sodium  bicarbonate.  The  history  sug- 
gests a  duodenal  ulcer. 

Percussion  made  during  the  time  the  head  was  ex- 
tended (Fig.  65)  demonstrated  a  dilated  stomach.  Pres- 
sure at  the  loth  dorsal  spine  elicited  the  dulness  of  the 
duodenum.  During  forced  inspiration,  the  area  of  gas- 
tric dulness  descends  showing  that  there  are  no  perigas- 
tric  adhesions.  When  the  patient  ingested  9  ounces  of 
water  (page  588),  the  stomach  remained  in  the  vertical 
position  for  10  minutes  (i  minute  in  the  norm).  It  was 
then  assumed  that  there  was  a  pyloric  obstruction.  The 
latter,  however,  was  a  spasm  of  the  pylorus,  for  when 
pressure  was  made  between  the  3rd  and  4th  dorsal  spines 
(which  releases  gastric  spasms,  page  589),  the  stomach  at 
once  assumed  its  normal  position.  The  dilatation  of  the 
stomach  it  was  assumed  was  likewise  caused  by  the 
spasm  and  not  a  mechanic  obstruction.  Further  con- 
firmation of  the  pyloric  spasm  was  elicited  by  the  fact  that 
pressure  at  the  5th  dorsal  spine  (page  588)  caused  an  in- 
crease in  the  percussional  area  of  the  pylorus. 

Over  the  area  of  gastric  dulness,  a  very  tender  spot 
(i  cm.  in  width)  was  palpated  which  shifted  upward  after 
concussion  of  the  2nd  lumbar  spine  and  downward  by 
concussion  of  the  i  ith  dorsal  spine  and  a  forced  inspira- 
tion. A  tender  spot  of  like  area  was  located  at  the  duo- 

595 


Spondylotherapy 

denum  but  which  showed  no  dislocation  on  inspiration 
nor  concussion. 

Freezing  the  3d,  4th  and  5th  dorsal  spines  (page  377), 
caused  the  area  of  gastric  tenderness  to  disappear  but 
did  not  influence  the  duodenal  point  of  sensitiveness. 

Diagnosis. — Ulcer  .of  the  stomach  and  duodenum. 

COMMENT. — The  presence  of  occult  blood  in  the  feces 
is  a  valuable  diagnostic  point. 

Exclusive  rectal  feeding  (not  even  water  by  the  mouth) 
causes  the  symptoms  of  gastric  and  duodenal  ulcer  to 
disappear  in  a  few  days  and  is  equally  diagnostic. 

Duodenal  ulcers  are  frequently  confused  with  gastric 
ulcer.  The  former  occur  usually  in  early  adult  life  and 
are  characterized  by  periodic  attacks  of  "stomach 
trouble."  Pain  and  tenderness  usually  extend  from  the 
mid-line  to  the  right  and  the  accentuation  of  symptoms 
due  to  ingested  food  occurs  several  hours  after  a  meal. 
The  so-called  "hunger-pain"  is  a  frequent  symptom. 

Auscultation  of  sounds  evoked  by  intestinal  peristalsis 
shows  that,  the  sounds  are  increased  in  intensity  during  the 
time  pressure  is  made  between  the  3d  and  4th  dorsal  spines 
and  that  they  become  less  loud  or  are  inhibited  during  the 
time  pressure  is  maintained  at  the  yth  cervical  spine. 

THE  LIVER. 

The  study  of  visceral  anatomy  or  organology  in  the 
conventional  way  in  the  dissecting  room,  gives  us  an  inade- 
quate conception  of  the  topographic  anatomy  of  the  living 
viscera.  This  criticism  is  equally  applicable  in  the  arraign- 
ment of  the  conventional  methods  of  percussion.  The  lower 
border  of  the  liver  may  be  cited  as  a  paradigm.  Percussed  in 
the  usual  way  and  compared  with  the  author's  methods  on 
page  598,  it  will  be  found  that,  it  is  usually  4  cm.  lower  than 
would  be  indicated  by  percussion  after  the  accepted  methods 

596 


The      Gall-Bladder 

(Fig.  139).  Reference  to  the  foregoing  observation  must  be 
recalled  in  locating  the  site  of  the  gall-bladder. 

By  what  the  author  designates  as  splanchnoscopy,  the 
observation  in  question  is  likewise  confirmed. 

The  ascent  and  descent  of  the  lower  border  of  the  liver 
may  be  observed  when  the  patient  is  placed  with  flexed 
knees  on  a  table  with  the  head  against  a  good  light.  The 
observer  stands  with  his  back  likewise  to  the  light  and  fixes 
his  vision  on  the  epigastrium.  The  patient  must  execute 
forced  breathing.  The  shadow  may  be  traced  to  both  sides 
of  the  median  line  of  the  epigastrium.  In  women,  owing  to 
the  thoracic  type  of  breathing  the  shadow,  is  less  evident. 

The  shadow  may  be  accentuated,  as  the  author  has  shown 
in  his  investigations104  of  the  phrenic  shadow,  by  painting 
the  skin  (embraced  by  the  shadow)  with  a  saturated  alco- 
holic solution  of  gamboge. 

THE   GALL-BLADDER. 

The  fundus  of  the  gall-bladder  projects  beyond  the  an- 
terior border  of  the  organ. 

A  line  drawn  from  the  right  acromion  process  to  the  um- 
bilicus crosses  the  costal  arch  approximating  the  location 
of  the  gall-bladder.  The  latter  in  its  long  diameter  measures 
from  7  to  10  cm.,  and  about  4  cm.,  in  its  greatest  transverse 
diameter. 

The  site  of  the  gall-bladder  varies  with  the  position  of 
the  lower  border  of  the  liver  and  the  latter  is  practically 
always  lower  than  the  description  in  the  conventional  text- 
book (page  596). 

The  reason  for  the  latter  error  is  obvious.  The  lower 
liver-border  is  immersed  in  an  atmosphere  of  tympanitic 
sound  and  its  edge  does  not  exceed  one  centimeter  in  thick- 
ness. 

597 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

The  usual  methods  of  percussion  are  untrustworthy  in 
defining  the  topography  of  the  organ. 

Two  methods  are  available  for  mapping  out  the  lower 
liver- border: 


FIG.  139. — Method  of  locating  the  gall-bladder  by  the  postural  method.  The 
dotted  line  represents  the  lower  border  of  the  liver  obtained  by  percussion  in  the 
usual  way.  The  heavy  line  represents  the  lower  border  obtained  by  the  postural 
method.  It  is  only  in  this  way  that  one  can  account  for  the  different  results  ob- 
tained by  clinicians  in  locating  the  lower  border  of  the  liver  which  is  really  lower 
than  is  currently  supposed. 

i.  Postural  method. — During  percussion,  the  patient 
inclines  the  body  backward  as  far  as  possible,  and,  to  re- 
lieve the  tedium  of  the  posture,  the  body  is  supported  by 
means  of  the  hands  resting  on  the  hips  or  by  an  assistant. 
Percussion  must  be  light  (Fig.  139). 

The  rationale  of  this  maneuver,  I  have  described  else- 

598 


Diagnostic      Data 

where103.  In  the  posture  suggested,  the  liver  is  approximated 
to  the  abdominal  parietes. 

2.  V ago-visceral  method. —During  light  percussion,  the 
head  is  fixed  in  the  position  as  shown  in  Fig.  65. 

The  rationale  of  this  method  involves  the  principle  of 
visceral-tone  and  is  described  on  page  451. 

Having  located  the  lower  liver-border  by  either  of  the 
foregoing  methods,  one  seeks  to  locate  the  gall-bladder  by 
percussing  in  the  directions  shown  in  Fig.  139. 

The  tympanitically-dull  area  of  the  gall-bladder  is  in 
marked  contrast  with  the  dulness  of  the  liver-border. 

In  percussing  the  gall-bladder,  the  postural  or  vago- 
visceral  method  must  be  maintained. 

Note  the  following  concerning  the  gall-bladder  area  of 
tympanitic-dulness : 

1.  It  descends  on  inspiration; 

2.  It  is  diminished  or  disappears  after  concussion  of  the 
4th,  5th  and  6th  dorsal  spines; 

3.  It  enlarges  after  concussion  of  the  Qth  dorsal  spine. 

DIAGNOSTIC  DATA. — The  pear-shaped  dulness  of  the  gall- 
bladder rising  and  falling  in  respiratory  rhythm  with  the 
liver  would  exclude  adhesions. 

Pain  due  to  disease  of  the  gall-bladder  may  be  accurately 
located. 

Riedel's  lobe  (a  freely  movable  linguiform  body),  which 
is  common  in  chronic  disease  of  the  gall-bladder,  may  be  de- 
termined by  percussion.  It  may  be  on  either  side  of,  or  over 
the  gall-bladder.  According  to  the  law  of  Courvoisier,  in 
cases  of  chronic  jaundice  due  to  obstruction  of  the  common 
bile-duct,  contraction  of  the  gall-bladder  signifies  that  the 
obstruction  is  due  to  a  stone;  dilatation  of  the  gall-bladder 
suggests  that  the  obstruction  is  due  to  causes  other  than  a 
stone. 

599 


Spondylotherapy 

This  law  is  based  on  the  fact  that  in  cholelithiasis,  the 
gall-bladder  is  the  site  of  chronic  inflammation,  and  is,  in 
consequence,  contracted  and  not  capable  of  dilatation. 
Hence,  if  percussion  shows  an  enlarged  gall-bladder,  chole- 
lithiasis may,  as  a  rule,  be  excluded,  and  it  is  evidence  in 
favor  of  a  neoplasm. 

TREATMENT. — In  the  absence  of  a  stenosis  or  obstruction 
in  the  common  duct,  concussion  of  the  4th,  5th  and  6th  dor- 
sal spines  eventuates  in  evacuation  of  the  contents  of  the 
gall-bladder. 

The  latter  maneuver  is  indicated  in  catarrhal  jaundice, 
infectious  cholecystitis  and  in  the  so-called  hepatic  inter- 
mittent fever  associated  with  gall-stones. 

Chronic  cholecystitis  is  usually  of  infectious  origin, 
and  infection  is  a  frequent  exciting  cause  of  gall-stone 
formation.  Owing  to  the  anatomic  arrangement  of  the 
cystic  duct  (infolding  of  the  mucosa  in  the  form  of 
valves),  free  drainage  of  the  gall-bladder  is  difficult  and 
the  method  suggested  in  treatment  may  be  executed. 

THE   PANCREAS. 

The  author,  as  a  result  of  his  limited  investigations,  finds 
that  the  secretion  of  the  pancreas  is  probably  increased  by 
concussion  of  the  4th,  5th  and  6th  dorsal  spines. 

The  investigations  were  based  on  the  more  recent  meth- 
ods of  determining  the  function  of  the  pancreas  by  testing 
for  the  presence  of  ferments  in  the  stool. 

Rapid  peristalsis  is  hastened  after  breakfast  of  mixed 
food  by  an  enema  and  calomel  (0.2  gm.)  and  phenolph- 
thalein  (0.5). 

Activity  of  the  pancreas  is  determined  by  the  presence 
in  the  stool  of  trypsin  and  amylopsin.  Their  absence 
suggests  pancreatic  insufficiency  or  obstruction. 

The  Wohlgemuth106  method  for  amylopsin  is  probably 

600 


The         P      a      n      c      r      e      a 

the  most  reliable.  One  prepares  a  i  per  cent,  solution  of 
Kahlbaum's  soluble  starch  prepared  on  a  water  bath  for 
about  ten  minutes  with  considerable  stirring.  In  the 
absence  of  a  fluid  stool,  5  gm.  of  stool  is  rubbed  up  with 
20  c.c.  of  a  physiologic  salt  solution  and  after  being  cen- 
trifuged  and  filtered  varying  solutions  of  this  stool-fil- 
trate are  added  to  5  c.c.  of  the  starch-solution  in  test- 
tubes.  Dilutions  of  i  to  10,  i  to  100  and  i  to  1000  suffice. 
To  the  solution  of  the  starch  in  the  test-tubes,  toluol  is 
added  and  the  whole  digested  for  24  hours  (38°  to  40°C.). 
At  the  end  of  this  period,  the  test-tubes  are  almost  filled 
with  tap-water  and  one  drop  of  tenth-normal  iodin  solu- 
tion is  added  to  each  tube.  If  the  starch  has  been  com- 
pletely digested  no  blue  color  appears  in  the  tube. 

The  estimation  is  made  in  units;  one  unit  representing 
the  ability  of  i  c.c.  of  stool-filtrate  to  transform  i  c.c.  of 
starch.  If  the  tube  containing  the  i  to  1000  dilution 
transforms  5  c.c.  of  starch-solution,  then  i  c.c.  of  undi- 
luted filtrate  is  capable  of  digesting  5000  c.c.  of  starch- 
solution.  This  represents  a  normal  finding  (5,000  units). 

The  minimum  number  of  units  is  100,  although  in  the 
tests  of  Heyn,10?  in  non-pancreatic  cases,  they  did  not 
fall  below  250  units. 

In  pancreatic  disease,  the  findings  may  be  50  units  or 
lower. 


601 


Spondyloth     e    r    a    p    y 


CHAPTER  XVI. 

PHYSIO-THERAPY    OF    PULMONARY   TUBERCULOSIS. 

ANEMIC  THEORY — CLINICAL  EVIDENCE — TRIANGLES  OF  GROCCO — 
METHODS  FOR  ELICITING  LUNG-HYPEREMIA — RESUME — TREAT- 
MENT— AUTHOR'S  TREATMENT — VISCERAL  VASCULARITY — BLOOD 
— VOLUME. 

ANEMIC  THEORY. — According  to  Rokitansky,  one  rarely 
encounters  pulmonary  tuberculosis  in  association  with  mitral 
insufficiency  for  the  reason  that,  in  the  latter  disease,  there 
was  congestion  of  the  pulmonary  vessels.  This  contention 
despite  its  assailment  still  holds. 


FIG.  140. — Semi-diagrammatic  representation  of  the  pulmonary  air-vesicles 
(Landois  and  Stirling),  v,  v,  blood-vessels  at  the  margins  of  an  alveolus;  c,  c,  its 
blood-capillaries;  E,  relation  of  the  squamous  epithelium  of  an  alveolus  to  the 
capillaries  in  its  wall;  f,  alveolar  epithelium  shown  alone;  e,  e,  elastic  tissue  of  the 
lung. 

Orth,  observed  that,  kyphotics  despite  their  limited 
respiratory  excursions  owed  their  immunity  to  tuberculosis 
in  consequence  of  congested  lungs. 


Clinical     Evidence 

In  pulmonary  stenosis,  tuberculosis  is  the  usual  sequela 
owing  to  pulmonary  anemia. 

It  was  the  belief  of  Bellinger,  that  tuberculosis  showed  a 
predilection  for  the  apices  for  the  reason  that,  they  were 
more  anemic  than  other  lung-areas  owing  to  gravity. 

The  influence  of  posture  on  the  blood  contained  in  the 
lungs  has  already  been  noted  on  page  290.  The  vascular 
supply  of  an  alveolus  is  shown  in  Fig.  140. 

While  the  amount  of  blood  in  the  lungs  is  influenced  by 
gravity,  this  static  factor  is  not  the  only  one.  A  very  impor- 
tant factor  is  the  activity  of  the  organ  (uH  irritatio,  ibi 
affluxus). 

Pulmonary  suction  refers  to  the  large  quantity  of  blood 
drawn  into  the  lungs  with  each  inspiration,  and  this  physio- 
logic process  has  not  been  inaptly  compared  to  a  species  of 
dry  cupping.  Chapman  avers,  "That  if  at  the  termination 
of  expiration  the  quantity  of  blood  in  the  lungs  is  from  1-15 
to  1-18  of  the  total  quantity  of  blood  in  the  body,  at  the  ter- 
mination of  inspiration,  it  will  be  from  1-12  to  1-13."  The 
pulmonary  vessels  expand  with  each  inspiration  and  con- 
tract during  expiration,  the  result  being  an  increased  flow 
of  blood  from  the  right  heart  and  lungs;  the  dilated  vessels 
as  Campbell  puts  it,  "actually  suck  the  blood  out  of  the 
right  heart." 

As  is  known,  lung-anemia  aids  caseation  of  tuberculous 
nodules.  Tuberculous  invasion  of  the  pulmonary  apices  is 
probably  due  to  impaired  circulation;  the  posture  of  the  body 
by  gravity  diminishing  the  supply  of  blood  to  the  upper  part 
of  the  lungs. 

CLINICAL  EVIDENCE. — One  meets  with  a  definite  clinical 
picture  antedating  pulmonary  tuberculosis  and  which,  in 
reality,  may  be  the  disease  itself.  The  lungs  are  hyperreso- 
nant  and  suggest  emphysema,  there  is  no  postural  lung- 

603 


S  p    o    n     d    y    I    o    t    h     e    r    a    p    y 

dullness  (page  290),  the  heart  is  small  and  enfeebled,  systolic 
murmurs  are  heard  over  the  pulmonary  artery  or  aorta  or 
both,  the  triangles  of  Grocco  cannot  be  elicited,  there  are 
zones  of  atelectasis  (page  299)  and  the  signs  of  pulmonary 
anemia  (page  301). 

Tissue  vulnerability  is  recognized  in  certain  diseases  like 
diabetes  and  we  anticipate  cutaneous  and  other  complica- 
tions because  sugar  is  demonstrated  in  the  urine.  In  pul- 
monary tuberculosis,  however,  this  tissue-susceptibility  is 
ignored,  although  the  pre tuberculous  lung  is  essentially  an 
emphysematous  lung,  and  characterized  by  hyperresonance, 
extension  of  the  lung-borders,  unchanged  percussion  note 
during  both  phases  of  respiration  and  restricted  movements 
of  the  diaphragm. 

One  ascribes  the  percussion  sound  over  the  lungs  to  vibra- 
tion of  the  chest- wall  and  the  air  within  the  lung-alveoli,  but 
another  factor  must  not  be  ignored,  viz.,  the  quantity  of 
blood  in  the  lungs. 

One  may  reproduce  this  lung-picture  of  the  pretuber- 
culous  lung  by  concussion  of  the  seventh  cervical  spine  and 
develop  an  antagonistic  picture  by  concussion  of  the  last  four 
dorsal  spines. 

In  the  latter  maneuver  the  maximum  effect  is  secured  at 
the  tenth  dorsal  spine. 

In  the  first  maneuver,  we  have  excited  the  reflex  of  the 
pulmonary  artery  (page  526)  and  diminished  the  quantity  of 
blood  in  the  lungs,  whereas  in  the  second  maneuver,  we  have 
dilated  the  pulmonary  vessels  (page  607),  and  increased  the 
quantity  of  blood  in  the  lungs. 

If  one  carefully  auscultates  the  pulmonary  and  aortic 
sounds  at  the  end  of  expiration  in  pulmonary  tuberculosis, 
one  will  be  astounded  at  the  frequency  with  which  murmurs 
of  a  functional  nature  are  encountered. 

604 


ClintcalEvidence 

These  murmurs  are  usually  systolic  pulmonary  and  aortic 
murmurs,  the  former  being  more  frequent  than  the  latter. 
No  note  is  taken  of  subclavian  murmurs  (page  533),  which 
are  relatively  frequent  in  phthisis. 

The  systolic  murmurs,  are  usually  soft  and  blowing 
sounds,  or  merely  whiffs  and  they  vary  in  character  and  ex- 
tent of  transmission  from  time  to  time. 

The  murmurs  in  question  may  be  due  to  anatomic  lesions 
but  in  the  majority  of  instances,  they  are  functional  and  due 
to  narrowing  of  the  pulmonary  artery  and  aorta  as  evidenced 
by  the  fact  that  they  disappear  temporarily  after  concussion 
of  the  tenth  dorsal  spine  which  dilates  both  vessels. 

The  coarctation  of  the  vessels  is  in  part  spasmodic  (page 
525),  for  the  reason  that  the  murmurs  are  heard  at  one  time 
and  are  absent  at  another  time. 

As  a  rule,  however,  the  diminished  lumina  of  the  vessels 
is  a  permanent  condition. 

Rokitansky  noted  that  too  voluminous  lungs  coupled 
with  a  small  heart  characterized  the  phthisical  habitus.  This 
observation  was  relegated  to  oblivion  until  revived  and  vig- 
orously defended  by  Brehmer. 

The  anemia  of  early  phthisis  suggests  chlorosis  and  has 
therefore  been  hyphenated  as  chloro-ammia. 

In  1872,  Virchow,  in  a  monograph,  called  attention  to  the 
fact  that  a  diminution  of  the  aortic  lumen,  attended  fre- 
quently by  anatomic  changes  in  its  walls,  was  the  almost 
invariable  result  of  an  autopsy  made  on  a  chlorotic  individual. 

In  some  typic  instances,  the  aorta  did  not  exceed  a  normal 
femoral  artery  in  caliber.  In  many  instances,  the  pulmonary 
artery  was  similarly  involved,  the  heart  was  small  and  its 
constituent  parts  proportionately  hypoplastic.  Another  phe- 
nomen  was  the  extreme  elasticity  of  the  arterial  walls. 

Pulmonary  anemia  (page  301),  is  one  of  the  most  impor- 

605 


Spondyloth     e    r    a    p    y 

tant  symptoms  of  early  phthisis.  The  hematologist,  however, 
does  not  concede  the  existence  of  anemia  in  tuberculosis, 
although  practically  every  clinical  symptom  negatives  the 
latter  observation.  It  is  quite  probable  that  while  the  blood 
of  the  peripheral  circulation  may  show  a  normal  blood  count, 
it  is  not  necessarily  so  with  the  blood  in  the  rest  of  the  body. 

The  investigations  of  the  author  show  that  the  quantity 
of  oxygen  in  the  blood  in  phthisis  is  diminished  (anoxe- 
mia)  and  that  the  increase  of  red  corpuscles  (polycythe- 
mia)  is  purely  compensatory  for  there  is  always  an 
increase  in  the  number  of  erythrocytes  in  the  blood  when 
the  normal  process  of  oxygenation  of  the  body  is  impaired 
(phthisis,  valvular  diseases,  emphysema,  chronic  bron- 
chitis, asthma)* 

In  the  phthisical  lung,  the  paravertebral  triangles  (tri- 
angles of  Grocco),  are  diminished  in  area  or  are  absent. 
These  triangular  areas  of  dullness  are  found  in  the  norm  on 
either  side  of  the  spine  (Fig.  141);  the  vertical  side  of  the 
triangle  corresponds  to  the  spine,  the  base  to  the  lower  border 
of  the  lung,  while  the  hypothenuse  extends  from  the  apex  to 
the  outer  and  lowest  point  of  the  base. 

The  triangles  of  Grocco  are  probably  due  to  passive  lung- 
hyperemia  as  shown  by  the  arrangement  of  the  blood-vessels 
in  Fig.  142.  The  triangles  are  probably  absent  in  phthisis 
owing  to  the  deficiency  of  blood  in  the  lungs. 

In  the  norm,  one  finds  an  area  of  dullness  or  diminished 
resonance  on  both  sides  opposite  the  3d,  4th  and  5th  dorsal 
spines  (Fig.  141).  I  shall  designate  this  area  as  the  vascular 
parallelogram,  because  it  corresponds  to  the  large  pulmonary 
blood-vessels.  It  disappears,  to  be  replaced  by  resonance 
when  the  yth  cervical  spine  is  concussed  and  is  accentuated 
after  striking  the  loth  dorsal  spine. 

In  the  norm,  one  may  augment  the  dull  area  of  the  para- 

606 


C   I 


i    n    i    c    a 


I      E    v    i   d 


e    n    c    e 


vertebral  triangle  by  concussion  of  the  tenth  dorsal  spine 
(which  increases  the  quantity  of  blood  in  the  lung),  or  dimin- 
ish the  area,  by  concussion  of  the  seventh  cervical  spine 
(which  decreases  the  blood  in  the  lung).  It  is  also  influenced 
by  posture  (page  290). 


FIG.  141. — Illustrating  the  site  of  the  vascular  parallelogram  above  and  the 
triangles  of  Grocco  below. 

Taking  an  average  patient,  one  finds  that  in  the  norm, 
if  the  paravertebral  triangle  measures  8  cm.  at  the  base,  after 
concussion  of  the  tenth  dorsal  spine,  it  may  be  increased  to 
15  cm. 

One  may  also  note  that  the  triangles  increase  in  area  at 
the  end  of  a  forced  inspiration  (pulmonary  suction,  page  603) 
and  diminish  in  area  at  the  end  of  a  forced  expiration.  An 
hypodermatic  injection  of  adrenalin  chlorid  (eight  minims), 
will  maintain  an  increased  area  of  triangular  dullness  for 
hours.  Thus,  before  an  injection,  the  base  of  a  triangle 
measured  8.6  cm.,  whereas  after  the  injection  (without 
previous  concussion),  it  measured  14.5  cm. 

607 


S  p 


o    n 


d    y    I 


t    h 


r    a    p    y 


The  area  of  the  paravertebral  dullness  may  be  selected  as 
a  guide  for  the  quantity  of  blood  in  the  lungs,  and  the  author 
in  investigating  different  maneuvers  for  augmenting  lung- 
hyperemia,  presents  the  following  table.  The  duration  of 
each  maneuver  was  one  minute. 


METHOD 

DIAMETER  OF 
TRIANGLE  AT  BASE 

DURATION  OF 
INCREASED  PARAVERTE- 
BRAL DULLNESS 

Concussion  at  both  sides  of  the 
loth  dorsal  spine. 

14.9  cm. 

One  minute. 

Direct  concussion  of  the  loth  dor- 
sal spine. 

10.5  cm. 

One-half  minute. 

Slow  sinusoidal  current  at  both 
sides  of  loth  dorsal  spine. 

16  cm. 

Two  and  one-half  minutes. 

Rapid  sinusoidal  current  at  both 
sides  of  loth  dorsal  spine. 

14  cm. 

One  minute. 

High-frequency  current  at  both 
sides  of  loth  dorsal  spine. 

11.9  cm. 

One  minute  and  forty  sec- 
onds. 

Pressure  at  both  sides  of  loth  dor- 
sal spine. 

15  cm. 

Three  minutes. 

Compare  the  foregoing  with  the  table  on  page 
398.  The  latter  refers  to  the  diffused  pulmonary 
dullness  the  result  of  an  increased  quantity  of  blood 
in  the  lungs. 

The  blood-supply  of  the  lungs  is  derived  from  the 
pulmonary  and  bronchial  arteries  (nutriment  for  the 
lung-tissues) .  Six  thousand  liters  of  blood  pass  through 
the  lungs  in  twenty-four  hours. 

RESUME. — The  author  believes  that,  anemia  of  the  lungs 
is  one  of  the  fundamental  conditions  predisposing  to  tuber- 
culous infection  and. that  therapeutic  maneuvers  which  pro- 
mote active  or  passive  hyperemia  of  the  lungs  are  indicated 
in  pulmonary  tuberculosis.  His  method  of  treatment  to  be 

608 


a 


m 


n 


described  presently  is  marvelously  efficient  in  early  cases  of 
the  disease,  but  in  advanced  cases,  his  results  in  the  main 
were  futile.  He  believes  furthermore,  that  in  tuberculosis 
of  the  joints,  the  surgeon  will  yet  evolve  a  method  of  paralyz- 
ing the  vasoconstrictor  nerves  of  a  vessel-wall  so  as  to  aug- 
ment the  supply  of  blood  to  the  implicated  joint. 


FIG.  142. — Illustrating    the    arrangement    of    the    pulmonary    blood-vessels 
(Schultze-Stewart,  atlas  of  Topographic  Anatomy). 


TREATMENT. — Several  writers,  notably  Kuhn  and  Jacoby, 
have  treated  phthisis  akin  to  the  lines  already  suggested. 
The  former  uses  a  mask  of  light  celluloid  with  an  adjustable 

609 


pondyloth 


r    a    p    y 


valve  which  shuts  off  some  of  the  air  entering  through  the 
mask,  which  induces  a  condition  of  suction-hyperemia  (Fig. 
143).  The  mask  is  used  primarily  in  the  morning  and  after- 
noon for  about  fifteen  minutes,  but  later  this  time  is  extended 
to  an  hour  or  even  more.  There  are  many  reports  concerning 
its  great  value  in  phthisis. 


FIG.  143. — Mask  of  Kuhn,  to  produce  suction — hyperemia  of  the  lungs. 

My  investigations  show  that,  the  use  of  the  mask  elicits 
a  moderate  increase  in  the  area  of  Grocco's  triangle. 

By  the  method  of  Jacoby,108  hyperemia  in  the  lungs  is 
induced  by  lowering  the  upper  part  of  the  trunk  by  a  special 
reclining  chair  (Fig.  144). 

"Autotransfusion,"  as  he  calls  his  method,  flushes  the 
apices  and  does  away  with  the  conditions  favoring  the 
tuberculous  process.  With  his  chair  the  entire  trunk 
lies  horizontally,  the  head  can  be  slightly  raised,  while 
the  legs  lie  higher  than  the  shoulders.  By  this  arrange- 
ment, the  pelvis  is  on  a  line  with  the  chest,  not  lower  than 
the  chest  according  to  the  usual  method  of  reclining. 

610 


Treatmen 


The  pelvis  can  be  raised  a  little  higher  than  the  chest  by 
an  interposed  cushion  which  supplements  the  hyperemia 
induced  by  the  autotransfusion  with  compression  of  the 
base  of  the  lungs  by  the  pressure  of  the  intestines  sliding 
down  against  the  diaphragm.  The  respiration  is  more 
of  the  costal  type,  and  the  lungs  are  much  better  ven- 
tilated when  the  trunk  is  lying  flat  than  when  the  patient 


FIG.  144. — Reclining  chair  of  Jacoby  for  autotransfusion. 

is  half  sitting  up,  possibly  with  the  shoulders  stooping 
forward;  this  actually  increases  the  tendency  to  anemia 
of  the  apices.  He  raises  the  feet  higher  by  an  inch  each 
three  days,  until  the  feet  are  18  inches  above  the  level  of 
the  head.  The  patients  find  that  they  can  breathe  more 
deeply  and  more  easily  and  that  expectoration  is  pro- 
moted. Usually  the  occasional  sharp  pains  in  the  chest 
disappeared  during  this  position  treatment.  The  hori- 
zontal attitude  is  not  so  agreeable  for  the  patients  as 
sitting  up  but  they  soon  become  accustomed  to  it  and 
like  it,  as  they  come  to  appreciate  the  benefit  therefrom. 
The  method  has  been  applied  in  various  sanatoria  in 
Germany  and  the  general  impression  seems  to  be 
favorable." 

The  investigations  of  Bier  show  that  hyperemia  is  na- 
ture's bactericide  which  is  expressed  in  inflammation  (page 
404). 

611 


S  p    o     n     d    y    I    o     t    h     e     r    a    p    y 

THE  AUTHOR'S  TREATMENT. — Every  possible  advantage 
is  taken  of  the  home-treatment  of  phthisis  by  the  hygienic  or 
open-air  method  which  may  be  summarized  as  follows: 

1.  Out-door  life  in  a  pure  air  for  every  variety  of  case, 
without  regard  to  symptoms,  in  all  weathers  and  seasons,  for 
whole  days,  and  when  possible,  all  night. 

2.  Hyperalimentation  by  means  of  nutritious  food,  prop- 
erly selected  and  prepared,  given  at  definite  and  frequent 
intervals. 

3.  Moderate  exercise  stopping  short  of  fatigue  and  an 
abundance  of  mental  and  physical  rest. 

4.  Judicious  medical  supervision  of  every  detail  of  the 
patient's  daily  life. 

The  reclining  chair  or  the  bed  must  be  inclined  after  the 
manner  cited  on  page  292. 

During  rest,  forced  inspirations  (which  increase  the 
volume  of  blood  in  the  lungs),  must  alternate  several  times 
a  day  with  seances  of  rapid  breathing  as  though  an  effort 
were  made  to  make  inspiration  and  expiration  as  short  as 
possible.  The  latter  exercise  is  similar  in  action  to  the  mask 
of  Kuhn. 

Daily  seances  of  concussion  at  the  office  of  the  physician 
must  be  supplemented  by  paravertebral  pressure  (page  467) 
at  the  home  of  the  patient.  To  protect  the  skin  from  the 
effects  of  pressure,  a  small  piece  of  adhesive  plaster  should 
be  fixed  on  either  side  of  the  tenth  dorsal  spine. 

Pressure  may  be  made  several  times  a  day  but  should  not 
exceed  one  minute  in  duration,  otherwise  the  pulmonary 
artery  reflex  of  dilatation  becomes  exhausted.  The  seance 
of  concussion  for  a  like  reason  should  not  exceed  fifteen  min- 
utes and  must  be  interrupted. 

If  the  treatment  employed  is  effective  in  evoking  the 
pulmonary  artery  reflex  of  dilatation,  the  resonance  of  the 

612 


The     Author's      Treatment 

lung  is  at  once  supplanted  by  dullness  on  percussion,  the 
triangles  of  Grocco  and  the  vascular  parallelogram  like- 
wise show  accentuated  dullness  and  an  augmented  area, 
and  any  systolic  murmur  over  the  pulmonic  ostium 
disappears. 

It  is  evident  to  the  reader  that,  the  rapid  sinusoidal  cur- 
rent may  substitute  concussion  and  may  in  fact,  be  more 
efficient  but  as  the  results  attained  by  the  author  have  been 
mostly  effected  by  concussion,  he  employs  the  latter  to  the 
exclusion  of  other  methods. 

SUPPLEMENTARY  TREATMENT. — A  daily  hypodermatic 
injection  of  adrenalin  (page  607)  may  be  employed  to  aid  the 
vascularity  of  the  lung. 

Another  efficient  aid  is  daily  inunctions  of  soft  green  soap 
(sapo  viridis),  one  dram  once  or  twice  a  day.  The  acutely 
enlarged  glands  in  scrofula  often  disappear  very  rapidly  by 
such  inunctions. 

The  tracheo-bronchial  lymph-glands  are  practically 
always  enlarged  in  phthisis  (page  79)  and  many  of  the 
symptoms  are  dependent  on  such  intumescence. 

The  almost  miraculous  results  with  sapo  viridis  in 
reducing  the  enlarged  glands  in  scrofula  have  suggested 
to  the  author  its  employment  in  phthisis. 

It  is  difficult  to  define  the  rationale  of  such  inunctions. 
Sapo  viridis  consists  principally  of  potassium  oleate. 

It  is  known  that  consumption  is  notably  absent 
amongst  laborers  in  lime  kilns  and  those  who  drink 
hard  water. 

The  phenomena  of  life,  according  to  Loeb,  depend 
upon  the  presence  in  the  tissues  of  a  number  of  the 
various  metal  proteids,  or  soaps  (Na,  Ca,  K,  and  Mg) 
in  definite  proportions. 

By  aid  of  the  calcimeter,  it  has  been  demonstrated  that 
there  are  a  number  of  diseases  dependent  on  an  excess 
or  diminution  of  lime  salts  in  the  blood.  When  the 

613 


S  p    o     n    d    y    I    o    t    h     e    r    a    p    y 

estimation  shows  an  excess  of  lime,  citric  acid  is  em- 
ployed, and  calcium  chlorid  when  the  lime  is  deficient. 
The  parathyroids  probably  control  calcium  metabolism. 
Symptoms  (muscular  twitching,  tachypnea,  etc.),  fol- 
lowing parathyroidectomy,  may  be  cured  by  intravenous 
injections  of  a  5%  solution  of  calcium  lactate. 

VISCERAL  VASCULARITY. — That  one  may  influence  the 
vascularity  of  tissues  by  stimulation  of  the  seventh  cervical 
spine  or  the  tenth  dorsal  spine  can  be  easily  demonstrated. 

During  the  time  that  a  rapid  sinusoidal  current  was  ap- 
plied I  have  had  several  competent  oculists,  notably,  Dr. 
Wm.  Hopkins  and  Dr.  Morton  Hart,  examine  the  eyes 
ophthalmoscopically.  All  noted  the  immediate  anemia  of 
the  fundus  when  the  current  was  applied  to  both  sides  of  the 
seventh  cervical  spine  and  hyperemia  of  the  fundus,  when 
application  was  made  at  the  tenth  dorsal  spine.  In  this  way, 
one  could  at  will  induce  hyperemia  or  anemia.  Expectant 
attention  on  the  part  of  the  observers  was  excluded  by  not 
apprising  them  of  the  object  of  my  investigations. 

The  same  precautions  were  taken  in  a  bronchoscopic 
examination  made  for  me  by  Dr.  Henry  Horn,  one  of  the 
most  competent  bronchoscopists  in  the  world.  His  report 
is  as  follows: 

"The  following  is  a  report  on  the  Bronchoscopic  find- 
ings in  the  case  of  Mr.  X.,  made  this  morning: 

The  examination  was  made  in  the  following  way:  A 
few  drops  of  a  3%  cocain  solution  was  sprayed  on  the 
posterior  pharyngeal-wall.  An  applicator,  dipped  twice 
in  a  20%  sol.  of  cocain  was  applied  to  the  interior  of  the 
larynx  but  did  not  extend  below  the  cords. 
EXAMINATION  i. 

The  region  just  above  the  bifurcation  was  very  care- 
fully examined  with  the  7.5  B running's  tube.  The 
mucous  membrane  was  very  pale  and  pasty  looking. 

614 


Visceral    Vascularity 

The  small  folds  between  the  rings  were  not  injected. 
Gradually,  occupying  a  time-period  roughly  estimated 
at  from  3-5  seconds,  the  folds  between  the  rings  gradu- 
ally became  very  distinctly  injected  and  one  could  see  a 
faint  rosy  blush  spreading  over  the  other  portions  of  the 
mucous  membrane.  After  an  interval  of  a  minute  the 
mucous  membrane  became  pale  again,  the  blush  dis- 
tinctly faded  and  the  injection  in  the  small  depth  between 
the  rings  became  paler  but  the  injection  did  not  entirely 
disappear.  This  phenomenon  was  repeated,  apparently 
at  the  will  of  the  operator  who  carried  out  some  electrical 
manipulation  which  I  could  not  follow,  several  times. 
One  could  distinctly  tell  when  the  pallor  commenced 
and  when  the  mucous  membrane  commenced  to  become 
more  congested. 

The  same  experiment  was  carried  out  in  the  larynx 
itself.  The  posterior  interarytenoid  space  was  selected 
because  there  was  a  very  tiny  plexus  of  veins  visible. 

Here  at  a  given  time  the  small  plexus  became  dis- 
tinctly paler,  and  after  a  few  seconds  interval  the  veins 
began  to  fill  and  the  blush  extended  distinctly  downward 
over  the  posterior  fold. 

A  patient  present  at  the  time  who  had  no  idea  of  the 
object  of  the  experiment,  was  told  to  look  down  the  tube 
and  tell  what  she  saw.  She  also  distinctly  saw  the  plexus 
grow  distinct1/  pale,  or  injected  at  the  will  of  the  opera- 
tor." 

Comment  by  the  Author, — Pallor  was  produced  with 
the  slow  sinusoidal  current  at  the  yth  cervical  spine  and 
congestion,  when  the  electrodes  were  applied  at  the  loth 
dorsal  spine.  The  laryngeal  changes  were  deserving  of 
special  consideration  insomuch  as  the  mucosa  was  al- 
ready blanched  by  the  cocain. 

If  one  inspects  the  nasal  mucosa,  one  may  observe 
anemic  or  hyperemic  effects  according  to  the  site  of  the 
application  of  the  current.  Like  vascular  phenomena 
are  demonstratable  in  the  ear-drum. 

Despite  the  contention  of  the  physiologist  that  the 

615 


Spondylo     t    h     e    r    a    p    y 

pulmonary  vessels  are  unprovided  with  vasomotor 
nerves,  the  clinical  investigations  of  the  author  suggest 
the  probable  incorrectness  of  the  dictum  in  question. 

The  fact  that  anemia  or  hyperemia  may  be  induced  at 
will  by  the  clinician,  suggests  many  possibilities  in  the 
treatment  of  disease.  Thus  insomnia  may  be  influenced, 
the  oculist  may  render  the  eye  anemic  in  ocular  inflam- 
mations, or  he  may  augment  the  supply  of  blood  in  con- 
ditions demanding  it.  However,  the  author  is  not  in  a 
position  to  speak  authoritatively  on  the  subject.  He 
merely  suggests  this  therapeutic  resource  in  the  treat- 
ment of  a  multitude  of  conditions  and  hopes  that  time 
and  the  experience  of  others  may  establish  its  value. 

He  believes  that  hemoptysis  may  be  controlled  by 
application  of  the  sinusoidal  current  (the  rapid,  pre- 
ferably) to  either  side  of  the  seventh  cervical  spine  and, 
in  the  absence  of  the  current,  pressure  may  be  used. 

The  author  may  be  permitted  to  observe  parentheti- 
cally, that  amyl  nitrite  is  the  most  efficient  and  expedi- 
tious expedient  we  possess  in  hemoptysis.109  Unless  it  is 
efficient  after  the  first  administration,  subsequent  in- 
halations do  no  good.  The  value  of  the  drug  for  this  pur- 
pose has  been  extensively  confirmed  and  Hare,  who 
signalizes  this  drug  as  a  specific  in  uterine  hemorrhages, 
claims  that  it  may  even  arrest  menstruation.  Atten- 
tion must  likewise  be  directed  to  the  author's  treatment 
of  LOCOMOTOR  ATAXIA.  He  started  from  the 
conviction  that,  the  lesions  peculiar  to  this  disease  are 
primarily  resident  in  the  spinal  vessels.  Thus,  the 
spinal  sclerosis  in  ergotism  resembles  in  distribution  the 
degeneration  peculiar  to  tabes.  One  also  finds  sclerosis 
of  the  dorsal  and  lateral  columns  associated  with  pro- 
found anemia. 

Now,  arteriosclerotic  vessels  are  not  rigid  tubes  but 
respond  to  reflex  influences  by  spasmodic  contraction. 
In  tabes,  the  paroxysmal  pains  and  crises  are  probably 
caused  by  a  transient  angiospasm  (paroxysmal  claudica- 
tion  of  spinal  cord),  and  the  author  has  frequently  re- 

616 


Comment    by    the    Author 

lieved  these  symptoms  by  inhalations  of  amyl  nitrite.  In 
early  tabes,  by  inhalation  of  the  latter,  he  has  tempo- 
rarily restored  the  lost  knee-jerk.  In  tabes,  concussion  of 
the  loth  dorsal  spine,  which  augments  the  vascularity  of 
^he  spinal  cord,  has  given  me  most  encouraging  results, 
coupled  with  concussion  of  the  lumbar  spines. 

The  eminent  clinician,  Dr.  H.  Jaworski,  of  Paris, 
France,  author  of  a  work  on  "locomotor  ataxia,"  reports 
several  remarkable  results  obtained  by  this  method.  In 
reporting  one  case,  he  comments  as  follows:  "Called 
into  consultation  by  a  confrere,  I  saw  the  hopeless  case 
of  a  woman,  who  was  unable  to  stand  for  five  years. 
After  a  seance  of  ten  minutes,  she  could  walk  without  a 
cane  and  now  comes  daily  to  my  office  for  further  treat- 
ment. Other  symptoms  have  improved.  This  case  is  a 
real  miracle." 

Another  curious  fact,  in  connection  with  the  author's 
treatment  of  phthisis  by  concussion  of  the  loth  dorsal  spine, 
is  the  enormous  increase  in  the  number  of  red  corpuscles 
following  the  maneuver.  This  increase  varies  from  100,000 
to  600,000  corpuscles  per  cubic  millimeter.  At  first  it  was 
supposed  that  this  artificial  polycythemia  was  due  to  some 
effect  on  the  bone-marrow  but  other  investigations  demon- 
strated that  pressure,  sinusoidal  and  high-frequency  cur- 
rents to  the  same  region  eventuated  in  like  results. 

Concussion  of  the  jth  cervical  spine,  on  the  contrary, 
caused  an  average  reduction  of  50x5,000  red  corpuscles. 
Estimations  were  made  immediately  after  concussion. 
Whereas  concussion  of  this  spine  causes  an  increase  in  the 
specific  gravity  of  the  blood,  concussion  oc  the  loth  dorsal 
spine  diminishes  the  specific  gravity. 

BLOOD-VOLUME. — The  foregoing  facts  suggest  many 
things  in  clinical  pathology,  notably,  the  causation  of 
edema  in  nephritis  (page  632).  Concussion  of  the  spines 
in  question  does  not  cause  any  appreciable  change  in  the 

617 


Spondyloth     e    r    a    p    y 

blood-pressure  which  is  in  accord  with  the  physiologic 
axiom  that,  when  the  vessels  are  overfilled  or  contain 
less  than  the  normal  quantity,  mechanisms  are  present 
for  maintaining  the  blood-pressure  at  its  normal  height. 
My  investigations  suggest  that  the  caliber  of  the  blood- 
vessels is  not  constant  and  that  the  change  in  lumen,  is 
practically  a  compensatory  angiospasm  or  angiectasis  to 
accommodate  respectively  a  decreased  or  increased 
volume  of  blood.  One  may  easily  demonstrate  in- 
creased volume  of  the  organs  after  concussion  of  the  loth 
dorsal  spine,  or  diminished  volume  by  concussion  of  the 
7th  cervical  spine. 

The  observation  of  the  older  writers  of  the  "full- 
blooded"  (plethora)  condition  of  the  patient,  played  an 
important  part  in  hematology,  but  the  observation  suc- 
cumbed to  the  rigid  analysis  of  modern  methods  despite 
the  fact  that,  its  confirmation  was  empirically  demon- 
strated by  the  relief  afforded  by  blood-letting.  Bleeding 
was  so  inconsistently  practiced  by  the  past  generations 
of  physicians  that  it  merited  the  rebuke  of  Van  Helmont, 
that  "a  bloody  Moloch  presides  in  the  chairs  of  medi- 
cine." Blood-letting  is  one  of  the  lost  therapeutic  arts. 
Formerly  we  bled  too  much,  but  now  we  do  not  bleed 
enough. 


618 


Treatment    of    Whooping    Cough 


CHAPTER  XVII. 

TREATMENT  OF  WHOOPING  COUGH. 

PERTUSSIS — AUTHOR'S  CONCEPTION  OF  PERTUSSIS — AUTHOR'S  TREAT- 
MENT— RESULTS  OF  TREATMENT — ANALYSIS   OF  TREATMENT. 

Although  it  is  conceded  that  pertussis  is  an  infectious  and 
contagious  disease,  the  nature  of  the  infection  has  not  been 
definitely  demonstrated.  A  bacillus,  resembling  the  bacillus 
of  influenza,  has  been  found,  which  many  believe  is  the 
pathogenic  organism  of  pertussis. 

The  disease,  after  a  period  of  incubation  lasting  from 
seven  to  ten  days,  is  characterized  by  a  catarrhal  and  par- 
oxysmal stage.  The  former  stage,  after  a  duration  of  from 
seven  to  ten  days,  is  succeeded  by  the  latter  stage,  in  which 
the  cough  becomes  more  convulsive  and  is  characterized  by 
the  distinctive  and  diagnostic  "whoop." 

Including  its  complications,  pertussis  is  the  most  fatal 
infectious  disease  in  children  under  the  age  of  five  years. 

Respecting  the  conventional  treatment  of  the  disease, 
the  therapeutic  pessimism  of  Osier  is  sententiously  expressed 
as  follows:  "Six  weeks  and  a  good  big  bottle  of  paregoric." 

The  entire  duration  of  an  average  case  of  pertussis  is 
from  ten  to  twelve  weeks  or  even  longer. 

Voelcker,110  in  his  contribution  embracing  a  careful  study 
of  over  550  cases  of  pertussis,  concludes  that,  "the  treatment 
of  whooping-cough  constitutes  one  of  the  reproaches  to  the 
art  of  medicine.  We  have  no  method  by  which  we  can 
shorten  the  disease,  nor  can  we  do  more  than  pilot  the  case 
to  recovery,  modifying  symptoms,  guarding  against  com- 

619 


Spondyloth     e    r    a    p    y 

plications,  and  making  our  patients  as  comfortable  as  we 
can  during  an  illness  which  has  no  rival  in  its  discomforts. 
A  specific  for  whooping-cough  has  yet  to  be  found.  To  all 
those  I  have  tried  (and  they  are  over  thirty  in  number),  the 
handwriting  on  the  wall  is  literally  applicable;  "Tekel" 
("Thou  art  weighed  in  the  balances,  and  art  found  want- 
ing.") 

THE  AUTHOR'S  CONCEPTION  OF  PERTUSSIS. — It  is  an  in- 
fectious disease  in  which  the  infection  diminishes  vagus-tone 
(chapter  XIII).  This  reduction  in  tone  specially  impli- 
cates the  vagus-fibers  innervating  the  aorta.  The  latter  ves- 
sel even  in  health  does  not  show  a  constant  lumen,  in  fact, 
its  caliber  is  modified  by  physiologic  conditions  and  periph- 
eral irritants  may  cause  it  to  dilate.  When  paroxysms  of 
pertussis  are  precipitated  by  emotions,  sneezing,  irritation 
of  the  throat,  etc.,  there  is  a  temporary  aortectasis.  Aortic 
dilatation  follows  emotional  disturbances  owing  to  an  in- 
crease of  adrenalin  secretion  (page  466.) 

I  have  made  careful  examinations  of  the  aortic  area  be- 
fore and  after  irritation  of  the  nose,  throat  and  other  regions 
and  noted  as  a  result  of  such  irritation,  an  invariable  increase 
in  the  caliber  of  the  aorta. 

In  an  infant  of  eight  months,  the  distance  between  the 
manubrium  sterni  and  the  vertebral  column  is  only  2.2  cm., 
and  it  is  quite  evident  that  the  slightest  increase  in  the  caliber 
of  the  aorta  will  produce  pressure-symptoms  on  important 
structures. 

Reference  to  Fig.  122,  will  show  the  important  structures 
contiguous  to  the  aorta  which  are  irritated  by  dilatation  of 
the  latter  and  symptoms  develop  somewhat  analogous  to 
aneurysm.  In  fact,  the  cough  of  the  latter  is  not  unlike  that 
observed  in  some  cases  of  pertussis. 

In  children  as  well  as  in  adults,  one  encounters  in  pe'r- 

620 


Treatment   of    Whooping     Cough 

tussis,  aphonia  and  dysphonia  which  we  are  inclined  to 
attribute  to  excessive  coughing,  whereas  in  reality,  they  are 
probably  pressure-symptoms.  I  have  noted  dysphagia  in 
two  adults  with  pertussis  and  one  knows  that  the  mere  act 
of  swallowing  may  precipitate  a  paroxysm  in  children.  We 
have  commented  on  the  limited  sagittal  diameter  of  the  chest 
in  children.  The  lumen  of  the  trachea  is  maintained  by 
vagus-tone  and  we  know  that,  when  the  latter  is  diminished, 
the  trachea  dilates  and  still  further  encroaches  on  the  limited 
intra-thoracic  area.  Changes  in  the  lumen  of  the  trachea 
are  more  frequent  in  children  than  in  adults  owing  to  the 
undeveloped  condition  of  the  bronchial  tree.*  Bronchoscopy 
shows  that,  even  in  the  norm,  the  systolic  projection  of  the 
left  tracheal  wall  by  the  adjacent  aorta  is  considerable. 

Aside  from  the  characteristic  "whoop,"  or  a  series  of  ex- 
piratory coughs  in  the  absence  of  the  latter,  and  a  marked 
leucocytosis  (chiefly  of  the  lymphocytes),  there  are  no  path- 
ognomonic  symptoms  of  pertussis. 

A  symptom  which  I  have  found  to  be  almost  invariably 
present  is  either  an  increase  in  the  area  of  aortic  dullness  on 
percussion  or  the  dullness  in  question  is  accentuated.  This 
may  be  found  in  adults  as  well  as  in  children.  The  area  of 
dullness  in  children  is  about  the  size  of  a  dollar  and  is  located 
over  the  arch  of  the  aorta  at,  or  on  either  side  of  the  manub- 
rium  sterni.  The  area  of  dullness  is  increased  by  pressure 
between  the  third  and  fourth  dorsal  spines  (page  472),  which 
reduces  vagus-tone  and  dilates  the  aorta  or,  by  concussion 
of  the  four  last  dorsal  spines  or  the  loth  dorsal  spine,  which 
provokes  the  aortic  reflex  of  dilatation  (page  255).  The  area 
of  dullness  is  diminished  or  disappears  by  increasing  vagus- 
tone  (pressure  at  the  seventh  cervical  spine  or  concussion  of 
the  latter). 

*According  to  Przewoski,  tracheal  dilatation  is  the  rule  in  chronic  coughs. 

621 


Spondyloth 


a    p    y 


Careful  percussion  of  the  aorta  must  be  executed  (page  558). 

DIFFERENTIAL  DIAGNOSIS. — Substernal  dullness  may  be 
confounded  with  the  following  conditions :  Atelectasis,  zones 
of  pulmonary  congestion,  bronchial  glands  and  an  enlarged 
thymus. 


HlGHT  TRACHCAL 
LYMPH   CLANO 


RIGHT  su 

TRACHCO 
BRONC 

LYMPH     CL»MD 


LlfT  TRACHtAl 
LYMPH  GLANO 


Vl 


BRONCHO' 
PULMONARY 
LYMPH  CIAN0 


V4 


INftRlOR 

HCO-BRONC 

LYMPH  GLAND 


FIG.  145. — The  tracheobronchial  and  bronchopulmonary  lymphatic  glands 
seen  from  in  front.  The  pointed  (?)  lymphatic  glands  and  lymph  vessels  are  not 
visible  from  in  front,  di,  d2,  first  and  second  dorsal  bronchial  branches;  vi,  va,  first 
and  second  ventral  bronchial  branches.  (Sukiennikow,  from  Gray's  Anatomy, 
Ed.  17.) 

The  patches  of  dullness  peculiar  to  the  latter  conditions 
show  no  variation  in  area  by  elicitation  of  the  aortic  reflexes. 

Atelectatic  areas  disappear  when  the  skin  is  irritated 
(page  301). 

Zones  of  congestion  disappear  after  elicitation  of  the 
methods  cited  on  page  292. 

622 


D  i  f  f  erential    Diagnosis 

Enlarged  bronchial  glands  may  develop  spasmodic  phe- 
nomena suggestive  of  pertussjs.  Reference  to  this  subject 
has  been  made  on  page  79.  Fig.  145  shows  the  location  of  the 
tracheobronchial  glands  and  suggests  the  sites  of  the  areas 
of  retrosternal  dulness  in  intumescence  of  the  glands. 

The  sign  of  D'Espine  consists  in  vertebral  auscultation 
along  the  spine  (yth  cervical  and  ist  dorsal  vertebrae), 
when  the  child  speaks  or  whispers  333.  There  is  a 
peculiar  resonance  when  the  bronchial  glands  are  en- 
larged and  the  sign  is  accentuated  when  the  head  is  bent 
forward;  this  position  brings  the  trachea  closer  to  the 
spine.  In  many  cases,  vertebral  bronchophony  is  present. 
Enlarged  glands  occur  more  often  on  the  right  than  on 
the  left  side. 

An  enlarged  thymus  gland  was  formerly  associated  with 
spasm  of  the  glottis  (laryngismus  stridulus),  and  the  attacks 
received  the  name  thymic  asthma.  I  have  reason  to  believe 
that  this  affection  as  well  as  spasmodic  croup  may  be  caused 
by  a  dilated  aorta,  if  the  successful  results  of  treatment 
(concussion  of  the  seventh  cervical  spine)  justify  such  a  con- 
clusion. 

The  thymus  attains  its  greatest  size  at  the  end  of  the 
second  year,  then  it  atrophies  and  disappears  at  puberty. 

A  persistent  thymus  causes  localized  dullness  along  the 
left  sternal  border  from  the  second  to  the  fourth  rib.  The 
normal  dullness  of  the  thymus  is  in  the  shape  of  a  truncated 
cone  with  base  at  the  sterno-clavicular  junction  and  apex  at 
the  level  of  the  2nd  rib.  In  the  norm,  the  gland  does 
not  extend  more  than  6  cm.  beyond  the  sternal  margins. 
An  X-ray  picture  may  be  positive  when  even  percussion  is 
negative. 

Bogg's111  directs  attention  to  the  following  sign  charac- 
teristic of  thymic  dullness,  based  on  the  fact  that  the  attach- 

623 


Spondyloth     e    r    a    p    y 

ment  of  the  gland  is  movable :  The  lower  border  of  thymus 
dullness  being  defined  (the  pleximeter-finger  still  in  place), 
retract  the  head  to  its  fullest  extent.  Thymus-dullness  rises 
upward  toward  neck,  leaving  a  clear  resonance  on  percussion. 
Mediastinal  glands  and  other  enlarged  structures  do  not 
show  this  shifting  dullness.  Aberrant  and  accessory  thyroids 
must  also  be  taken  into  account  in  the  differentiation  of 
retrosternal  dullness. 

THE  AUTHOR'S  TREATMENT  OF  PERTUSSIS. — This,  as  al- 
ready suggested,  is  based  on  the  hypothesis  that  there  is  a 
local  vagus-hypotonia  involving  the  fibers  innervating  the 
aorta  and  that,  while  the  disease  is  not  necessarily  curtailed, 
its  violence  is  minimized  by  subduing  the  factor  (aortectasis) 
to  which  may  be  attributed  many  of  the  symptoms. 

There  is  little  doubt  in  the  mind  of  the  writer  that  some 
infections  are  responsible  for  a  like  condition.  Thus  diph- 
theria is  said  to  be  complicated  with  pertussis  (perhaps  a 
pseudo-pertussis).  Here,  the  vagus-hypotonia  may  not  only 
be  responsible  for  the  characteristic  cough  but  also  for  the 
heart-symptoms  and  paralyses  peculiar  to  diphtheria.  The 
suggestion  having  been  made,  the  author  awaits  the  con- 
firmation of  his  theory. 

The  following  letter  was  addressed  to  a  few  colleagues : — 

"The  following  simple  method  has  arrested  the 
paroxysms  of  whooping-cough  in  a  number  of  patients  in 
from  3  to  7  days: 

"Place  a  pleximeter  upon  the  spinous  process  of  the  yth 
cervical  vertebra  and  strike  the  pleximeter  a  series  of 
moderate  blows  with  a  percussion-hammer.  The  num- 
ber of  blows  is  of  little  moment  but  the  blows  must  be  as 
strong  as  the  child  can  tolerate  without  flinching.  Some 
of  the  mothers  accompany  the  blows  with  a  nursery 
rhyme  or  song  to  interest  the  child.  In  the  absence  of  a 
pleximeter  and  percussion-hammer,  a  strip  of  linoleum 

624 


Authors     Treatment    of    Pertussis 

and  a  tack-hammer  will  suffice.  To  avoid  cutaneous 
irritation,  cotton  may  be  interposed  between  the  strip 
of  linoleum  and  the  spine.  Each  seance  during 
the  interparoxysmal  period  should  last  5  minutes  thrice 
daily  and  the  harmless  method  may  be  executed  by  the 
mother  or  nurse.  The  undersigned  is  desirous  of  col- 
lecting reports  on  this  method  of  treatment  from  his 
colleagues  and  to  test  the  efficiency  of  the  treatment,  it 
would  be  well  to  note  the  number  and  severity  of  the 
paroxysms  before  and  after  treatment  in  each  patient. 

"The  undersigned  will  explain  the  rationale  of  the 
method  in  a  contemplated  contribution  and  will  ap- 
preciate the  reports  sent  to  him  by  his  confreres. 

"This  method  has  also  succeeded  in  some  cases  of 
laryngismus  stridulus." 

Pressure  (page  467),  or  the  sinusoidal  current  to  the 
seventh  cervical  spine,  would  prove  equally  effective  but  the 
results  noted  refer  to  the  use  of  concussion  only. 

A  number  of  replies  were  received  from  physicians 
throughout  the  United  States  who  came  to  San  Francisco  to 
study  the  methods  of  spondylotherapy  and  from  others.  A 
few  replies  will  be  cited. 

DR.  GEO.  H.  BAERT,  GRAND  RAPIDS,  MICH.: 

"I  have  cured  by  your  concussion-method,  more  than 
twenty  cases  of  pertussis  within  two  weeks.  Last  week, 
a  patient,  Mrs.  S.,  age  30,  consulted  me  for  whooping- 
cough.  She  received  only  four  treatments  and  her 
paroxysms  ceased  after  the  second  treatment." 

DR.  A.  L.  GATES,  Los  ANGELES,  CAL.: 

"Mrs.  X.  had  approximately  24  paroxysms  in  twenty- 
four  hours.  After  three  days,  paroxysms  were  reduced 
to  six  a  day.  The  disease  was  not  curtailed  in  duration, 
perhaps  owing  to  the  fact  that  the  rapid  improvement 
noted  by  the  patient  caused  her  to  neglect  coming  to  my 

office." 

..  t 

625 


Spondyloth     e    r    a    p    y 

DR.  E.  GALLIMORE,  SAN  JOSE,  CAL.: 

"Patient,  age  71  years.  Whooping-cough  for  8  days 
with  10  to  12  paroxysms  in  the  twenty-four  hours.  After 
three  days,  paroxysms  reduced  to  three  in  twenty-four 
hours,  of  a  very  mild  character  and  patient  declares 
herself  as  well." 

"Patient,  age  3  years.  Seven  to  eight  paroxysms  in 
twenty-four  hours,  and  very  severe  at  night.  After 
treatment  for  seven  days  her  aunt  informs  me  that  the 
paroxysms  are  so  mild  and  infrequent  that  they  are  not 
noticed." 

"Patient,  age  4  years.  Five  to  six  paroxysms  in  twenty- 
four  hours  reduced  to  three  attacks  in  the  same  time 
after  one  week." 

"Patient,  age  6  years.  Before  treatment,  eleven  to 
fourteen  paroxysms  in  twenty-four  hours.  Reduced  in 
one  week  to  five  mild  attacks." 

"Age  1 8  months.  Six  to  eight  severe  paroxysms  in 
twenty-four  hours.  After  one  week,  reduced  to  three 
milder  attacks." 

."Age  2  years.  Fifteen  paroxysms  before  treatment. 
After  four  days,  reported  to  have  had  only  one  attack 
during  night." 

"Age  3  years.  When  treatment  was  commenced,  was 
having  six  to  nine  attacks  in  twenty-four  hours.  After 
six  days,  is  practically  cured." 

Ten  other  cases  are  reported  by  Dr.  Gallimore,  and 
the  results  correspond  with  those  cited. 

DR.  L.  LORE  RIGGIN,  OAKLAND,  CAL.: 

"If  a  drug  could  be  found  to  produce  such  a  marked 
change,  we  would  herald  it  as  "The  find  of  the  day." 
Treatment  of  itself  is  of  great  value  but  I  find  need  at 
times  to  give  a  placebo  to  satisfy  parental  minds.  The 
great  trouble  is  to  get  the  parents  to  persist  in  the  treat- 
ment and  to  make  the  percussion  sufficiently  hard.  The 
results  are  in  direct  proportion  to  the  care  and  attention 
of  executing  the  treatment.  It  is  very  gratifying  to 
know  that  the  disease  need  not  "run  its  course."  In  no 

626 


Analysis  of  Treatment  in   Pertussis 

case  has  there  been  a  single  complication  and  no  patient 
has  lost  flesh.  One  very  interesting  case  came  under 
my  care  after  suffering  intensely  for  six  weeks;  the 
mother  was  very  much  discouraged  and  willing  to  do 
anything.  Patient  was  nine  years  old,  had  lost  flesh  and 
had  a  bad  bronchitis.  This  patient  returned  to  school, 
with  weight  restored,  in  less  than  three  weeks." 
Some  random  reports  are  as  follows: 

"Attacks  every  hour  during  the  night.  Treatment 
commenced  in  third  week  of  disease.  After  the  fourth 
day  no  attacks  at  night." 

"Noiseless  concussion-hammer  (electric)  used  on  a 
child,  age  6  years.  Treatment  lasted  ten  minutes.  No 
attacks  after  the  first  treatment.  Sister  of  this  patient 
had  a  continuance  of  attacks  of  less  severity,  even  after 
eight  treatments." 

"Infant.  Attacks  partially  controlled  in  two,  and 
completely  after  five  days.  In  a  boy  in  the  same  family, 
no  apparent  results." 

"The  results  of  your  treatment  are  in  proportion  to 
the  efficiency  of  its  execution.  All  my  cases  (14),  have 
progressed  splendidly,  excepting  two,  in  the  family  of  a 
physician." 

"A  child  had  lost  very  much  in  weight  in  consequence 
of  vomiting  following  severe  attacks.  Vomiting  no 
longer  occurred  when  treatment  was  given  just  before 
meals,  and  the  patient  rapidly  regained  weight." 

ANALYSIS  OF  TREATMENT  IN  PERTUSSIS. — An  analysis  of 
the  medicinal  and  non-medicinal  therapy  of  this  disease 
demonstrates  two  things :  An  inhibition  or  an  augmentation 
of  vagus-tone.  Reference  on  page  453  has  already  been  made 
to  the  influence  of  drugs  on  the  tone  of  the  vagus. 

Belladonna  shows  its  best  action  when  pushed  to  its  full 
physiologic  effects.  Here,  the  results  are  attained  by  dimin- 
ishing vagus-tone  (page  472). 

Antipyrin,  one  of  the  most  efficient  drugs  in  subduing  the 

627 


Spondyloth     e    r    a    p    y 

paroxysms,  likewise  achieves  its  action  by  reducing,  but  not 
like  the  former  drug,  by  annihilating  vagus-tone. 

Many  years  ago,  sulphate  of  quinin,  was  regarded  as  a 
specific  in  whooping-cough,  used  in  solution  as  a  spray  to  the 
mouth  and  throat.  This  method  was  abandoned.  As  a 
matter  of  fact,  the  author  finds  that  quinin  given  to  secure 
and  maintain  its  physiologic  action  is  one  of  the  very  best 
drugs  for  increasing  vagus-tone  (page  505). 

By  the  use  of  Kilmer's  belt,  it  is  claimed  that  the  vomiting 
spells  in  pertussis  are  reduced  from  85  to  95  per  cent.  A 
band  of  linen  is  used,  4  to  5  inches  wide  and  3  inches  less  in 
length  than  the  circumference  of  the  abdomen  of  the  child 
at  the  navel,  with  two  strips  of  elastic  webbing,  each  two 
inches  wide  let  in  at  each  side,  the  whole  belt  lacing  at  the 
back.  The  belt  must  be  tight  and  worn  night  and  day. 

The  results  with  the  belt  are  no  doubt  effected  by  reflex 
stimulation  of  the  vagus  (page  208).  We  know  that  pressure 
upon  the  abdomen  will  stimulate  the  vagus  even  to  inhibition 
of  the  heart.  Thus,  when  Ho'nck,112  recommends  abdominal 
massage  in  the  treatment  of  pertussis,  claiming  cures  in  less 
than  three  weeks,  the  results  are  probably  attained  by  reflex 
stimulation  of  the  vagus. 

In  conclusion,  attendants  should  learn  the  following 
simple  method  of  inhibiting  paroxysms  of  pertussis;  press 
the  lower  jaw  of  the  patient  downward  and  forward  as  is 
often  done  during  the  administration  of  an  anesthetic  to 
bring  the  tongue  forward. 


628 


Miscellaneous     Data 


CHAPTER  XVIII. 

MISCELLANEOUS  DATA. 

FURTHER  ADVANCES  IN  THE  UTILIZATION  OF  THE  KIDNEY  REFLEXES 
— PROSTATIC  HYPERTROPHY  —  REFLEXOTHERAP  Y  —  SPOND  YLO- 
THERAPY  IN  THE  ETIOLOGY  OF  DISEASE — SYNOPTIC  TABLES 
OF  SPONDYLODIAGNOSIS,  SPONDYLOTHERAPY  AND  PHARMA- 
COLOGY OF  THE  REFLEXES — SPOND YLO-THERAPEUTIC  ARMA- 
MENTARIUM. 

FURTHER   ADVANCES   IN   THE   UTILIZATION   OF   THE   KIDNEY 

REFLEXES. 

On  page  359,  reference  has  been  made  to  the  kidney 
reflexes  and  it  was  noted  that  the  kidney  reflex  of  dilatation 
was  elicited  by  concussion  of  the  6th  to  the  8th  dorsal  spines 
and  the  counter  reflex  of  contraction,  by  concussion  of  the 
1 2th  dorsal  spine.  Since  then,  however,  the  author  has 
found  that  a  more  decided  contraction  of  the  kidney  can  be 
evoked  by  concussion  of  the  jth  cervical  spine,  and  a  more 
decided  dilatation,  by  concussion  of  the  roth  dorsal  spine. 

Without  entering  into  the  details  of  the  investigations,  it 
suffices  to  say  that  the  kidney  reflexes  in  the  primary  instance 
(page  359),  were  caused  by  contraction  and  dilatation  of  the 
renal  parenchyma,  whereas  when  the  yth  cervical  and  loth 
dorsal  spines  were  concussed,  concussion  of  the  former  con- 
tracted the  blood-vessels  of  the  organ  and  thus  diminished 
the  volume  of  the  kidney,  whereas  concussion  of  the  loth 
dorsal  spine,  dilated  the  blood-vessels  and  thus  augmented 
the  volume  of  the  organ  (vascular  kidney  reflexes). 

In  discussing  the  subject  of  visceral  vascularity.  on  page 

629 


S  p     o     n     d    y    I    o     t    h     e     r    a    p    y 

614,  et  seq.,  the  effects  of  concussing  the  7th  cervical  spine 
and  loth  dorsal  spine  were  noted. 

The  effects  of  concussing  the  latter  spines  were  investi- 
gated in  a  dual  direction ;  by  percussing  the  outer  border  of 
each  kidney  and  by  functional  tests  of  renal  efficiency.  In 
the  average  subject,  the  outer  border  of  the  right  kidney  is 
approximately  distant  9  cm.  from  the  spinous  processes  and 
the  left  kidney,  7  cm.  The  average  degree  of  contraction 
of  the  kidney  (estimated  from  the  outer  border)  after  con- 
cuss*, on  of  the  7th  cervical  spine  was  1.6  cm.,  and  the  dilatation 
of  the  organ  (estimated  from  the  outer  border),  after  con- 
cussion of  the  loth  dorsal  spine  was  2.6  cm.  A  few  blows 
of  the  hammer  on  the  appropriate  spinous  processes  suffice 
to  elicit  the  reflexes  which  are  of  short  duration. 

FUNCTIONAL  TESTS. — With  the  kidney  reflexes  which  con- 
tracted and  dilated  the  renal  parenchyma  (page  359),  elimin- 
ation was  delayed.  Here,  contraction  and  dilatation  of  the 
parenchyma,  as  with  the  myocardium  (page  543),  contracted 
the  renal  blood-vessels. 

After  concussion  of  the  7th  cervical  spine,  which  con- 
tracted the  renal  blood-vessels,  elimination  was  likewise 
delayed,  whereas,  after  concussion  of  the  loth  dorsal  spine, 
elimination  was  hastened  in  the  norm,  as  well  as  among 
nephropaths. 

In  several  instances,  in  subjects  with  parenchymatous 
nephritis,  phloridzin  glycosuria,  which  did  not  take  place 
after  several  hours,  occurred  within  the  normal  period  of 
time  after  5  minutes  concussion  of  the  loth  dorsal  spine. 

Among  the  simplest  and  most  reliable  tests  for  renal 
sufficiency  is  that  with  phloridzin;  1 5  minims  of  phlorid- 
zin solution  (1:200)  by  subcutaneous  injection  causes 
sugar  to  appear  in  the  urine  in  a  healthy  subject  in  from 
15  to  30  minutes  and  the  glycosuria  continues  from  2  to 

630 


Fun 


o    n    a 


T    e 


s    t   s 


4  hours.  The  most  important  factor  is  the  total  quantity 
of  sugar  eliminated,  which  varies  from  i  to  2  grams. 
Diminished  or  delayed  phloridzin-glycosuria  usually  in- 
dicates a  renal  disease,  and  a  complete  absence  of  sugar 
may  be  regarded  as  a  sign  of  advanced  renal  disease. 


FIG.  146. — Posterior  view  of  the  opened  head,  neck  and  trunk.  The  relation 
of  the  kidneys  to  the  surface.  Compare  with  Fig.  n.  (Atlas  of  Topographic  An- 
atomy, Schultze-Stewart.) 

631 


Spondyloth     e     r    a    p    y 

Before  formulating  any  conclusions  concerning  the  prac- 
tical value  of  concussion  of  the  loth  dorsal  spine  in  the  treat- 
ment of  nephritis,  succinct  reference  must  be  made  to  the 
pathology  of  the  latter  disease. 

Definite  knowledge  concerning  nephritis  began  with 
Bright,  in  1827,  and  this  has  been  supplemented  since 
then  by  the  observations  of  pathologists  and  clinicians. 
More  recently,  an  experimental  study  of  nephritis  has 
been  attempted  to  explain  the  prominent  symptoms  of 
the  disease. 

Albuminuria  is  caused  by  increased  permeability  of 
the  glomerular  tuft  and  degeneration  of  the  epithelial 
cells  of  the  tubules,  thus  permitting  the  soluble  proteids 
in  the  blood  to  appear  in  the  urine. 

The  urinary  casts  arise  either  from  degenerated 
epithelium  or  from  albumin  excreted  through  the  glom- 
eruli.  The  paroxysmal  appearance  of  a  large  number  of 
casts  ("cast-showers"),  is  caused  by  augmented  renal 
circulation  with  associated  diuresis,  After  concussion  of 
the  loth  dorsal  spine,  cast-showers  were  demonstrable, 
even  though  casts  were  absent. 

Uremia  is  most  probably  caused  by  the  retention  of 
unknown  toxic  products,  which  in  the  norm  are  excreted 
by  healthy  kidneys. 

Edema  has  been  ascribed  to  a  variety  of  factors, 
notably,  an  abnormal  distribution  of  fluid  in  the  body 
(von  Koranyi),  which  the  French  school  attributes  to 
the  retention  of  sodium  chlorid  (there  is  a  diminished 
execretion  of  chlorids  in  nephritis)  in  the  tissues,  and 
that  the  latter  in  consequence  require  a  greater  amount 
of  water  to  maintain  the  salt  in  solution.  More  recently, 
a  non-renal  factor — altered  permeability  of  the  cutaneous 
blood-vessels,  has  been  suggested  to  explain  nephritic 
edema.  Here,  a  problematic  renal  toxin  injures  not 
only  the  blood-vessels  of  the  kidneys,  but  all  the  blood- 
vessels. 

Hypertension  and  cardiac  hypertrophy,  have  been  at- 

632 


C      o      n      c      I      u 


n 


tributed  to  a  destruction  of  the  renal  parenchyma  and  to 
an  internal  secretion  of  the  kidney. 

In  summarizing  the  results  thus  far  attained  by  ex- 
perimental methods,  it  is  safe  to  conclude  that  they  have 
given  us  no  clue  respecting  the  etiology,  prevention  and 
cure  of  nephritis. 

CONCLUSIONS. — "Reasons  drawn  from  the  urine  are  as 
brittle  as  the  urinal." 

Albuminuria  is  no  more  an  expression  of  renal  disease 
than  is  a  murmur  an  expression  of  cardiac  disease  (page  525). 

Just  as  we  test  the  competency  of  the  heart-muscle  (page 
510)  and  disregard  murmurs  in  a  prognostic  direction,  so 
must  we  disregard  albumin  and  content  ourselves  with  de- 
termining whether  the  kidneys  functionate  adequately  as 
niters.  Albuminuria  may  occur  with  or  without  renal 
lesions. 

Thus,  orthostatic  albuminuria  (page  122),  is  differ- 
entiated from  albuminuria  dependent  on  renal  lesions 
by  the  following  test:  If  calcium  lactate  (usual  dose),  is 
given  for  two  days  in  succession,  albumin  will  disappear 
if  it  is  orthostatic,  but  will  persist  if  renal  lesions  are 
present.  It  is  here  assumed  that  the  orthostatic  form  is 
caused  by  diminished  coagulability  of  the  blood,  which 
is  increased  by  calcium. 

Concussion  of  the  loth  dorsal  spine  increases  the  func- 
tional efficiency  of  the  physiologic  and  pathologic  kidney 
and,  by  rendering  the  kidneys  hyperemic,  one  is  in  possession 
of  a  puissant  agent  (page  404)  in  contending  with  renal 
lesions,  notably  those  in  which  the  blood-supply  is  impli- 
cated. 

The  quantity  of  blood  in  the  kidneys  may  be  determined 
by  the  vascular  reflexes  of  these  organs  (page  629).  In 
diagnosis,  these  reflexes  are  equally  valuable.  In  certain 

633 


Spondyloth     e    r    a    p    y 

nephritides,  when  the  increase  in  connective  tissue  is  at  the 
expense  of  the  secreting  structures,  the  vascular  kidney  re- 
flex of  dilatation  is  either  absent  or  diminished  in  amplitude. 

The  author's  theory  of  nephritic  edema  has  already  been 
discussed  (page  617),  and  he  utilizes  concussion  of  the  loth 
dorsal  spine  in  the  treatment  of  edema  whether  of  cardiac 
or  renal  origin. 

Later  (page  641),  it  will  be  shown  that,  concussion  of  the 
yth  cervical  spine  may  compromise  the  secretory  efficacy  of 
the  kidneys. 

PROSTATIC  HYPERTROPHY. 

The  prostate  has  a  fibromuscular  capsule  which  sends  a 
median  septum  inward  (surrounding  the  urethra),  dividing 
the  parenchyma  of  the  gland  into  about  forty  lobules.  The 
prostatic  muscular  tissue,  is  made  up  of  unstriated  fibers  and 
the  second  sphincter  (vesical  or  prostatic  sphincter),  has 
striated  as  well  as  smooth  muscle-fibers. 

The  etiology  of  prostatic  hypertrophy  is  not  definitely 
known  and  recalls  the  observation  of  Sir  Henry  Thompson, 
that  the  best  proof  of  our  ignorance  concerning  the  cause  is 
furnished  by  the  manifold  factors  which  are  made  responsible 
for  its  existence.  Some  ascribe  the  hypertrophy  to  a  chronic 
prostatitis  usually  due  to  gonorrheal  infection,  whereas  others 
deny  this  relationship. 

The  symptomatology  of  the  disease  is  essentially  limited 
to  the  obstruction  of  the  urinary  flow  caused  by  the  enlarged 
prostate. 

Rectal  palpation  demonstrates  the  characteristic  ball-like 
shape  of  the  prostate  and  absence  of  the  raphe  between  the 
lateral  lobes. 

Urinary  symptoms  are  not  always  dependent  on  the  size 
of  the  gland;  a  small  gland  may  produce  severe  symptoms, 

634 


Author  s  Treatment  of  Prostatic   Hypertrophy 

whereas  an  enormously  enlarged  prostate  may  be  unattended 
by  symptoms. 

One  must  also  differentiate  between  simple  hypertrophy 
and  malignancy  and  recall  the  observations  of  Young,  viz., 
that  one  of  four  cases  of  prostatic  hypertrophy,  malignancy 
is  present. 

AUTHOR'S  TREATMENT  OF  PROSTATIC  HYPERTROPHY. — It 
has  been  established  empirically  that,  the  best  site  for  con- 
tracting the  prostate  corresponds  to  the  i2th  dorsal  spine. 
The  rapid  sinusoidal  current  is  used ;  the  interrupting  elec- 
trode (Fig.  46)  is  fixed  at  the  i2th  dorsal  spine  and  a  large 
electrode  in  the  sacral  region.  Strong  currents  must  be 
employed.  With  the  finger  palpating  the  prostate  during  the 
action  of  the  current,  one  may  note  reduction  in  the  size  of 
the  gland. 

All  hypertrophic  prostates  do  not  equally  respond  and 

when  this  occurs,  little  can  be  expected  from  this  method. 

In  the  latter  case,  the  stage  of  active  parenchymatous  and 

muscular  hyperplasia  has  been  succeeded  by  an  overgrowth 

of  fibrous  connective  tissue. 

Results,  if  any,  are  immediate,  irrespective  of  the  stage 
of  prostatism. 

Treatment  should  be  executed  daily  until  definite  results 
are  attained. 

Chromium  sulphate  (4  to  8  grains  three  times  a  day 
after  meals),  is  a  useful  medicament  in  prostatic  hyper- 
trophy. The  value  of  this  drug  was  first  established 
empirically  by  Kolipinski,113  who  likewise  vaunts  it  as  a 
specific  in  exophthalmic  goitre  and  established  its  value 
in  locomotor  ataxia  and  neurasthenia.  Unfortunately, 
this  drug  is  destined  to  have  only  a  limited  use  until  its 
value  has  been  established  on  a  more  rational  foundation. 
My  limited  investigations  show  that  it  has  a  powerful 
vagotropic  action  (page  451),  notably  on  the  sacral  au- 
tonomic  fibers  (Fig.  101). 

635 


Spondyloth     e     r    a    p    y 

REFLEXOTHERAPY. 

Reference  to  the  employment  of  reflexes  in  treatment  has 
already  been  made  on  page  392.  Jaworski,  of  Paris,  digni- 
fies this  method  by  the  neologism,  reflexotherapy  and  refers 
specifically  to  the  methods  of  the  author  as  "vertebral  reflex- 
otherapy." 

All  diseases  are  manifested  by  a  direct  and  an  indirect 
symptomatology;  the  latter  embraces  the  reflex  symptoms.' 
There  are  individuals  who  are  reflexophilic,  i.  e.,  they  have 
exaggerated  reflexes. 

The  Laborde  method  of  resuscitation  in  asphyxia,  by 
rhythmic  traction  of  the  tongue,  is  an  excellent  example  of 
the  employment  of  a  reflex.  The  investigations  of  the  author 
show  that,  such  lingual  traction  provokes  a  heart  reflex  of 
great  amplitude  and  long  duration.  Furthermore,  it  aug- 
ments the  tone  of  the  vagus  and  may  be  employed  to  secure 
the  latter  effect,  in  addition  to  the  methods  described  on  page 
199. 

In  making  a  comparative  estimate  of  the  methods  em- 
ployed for  eliciting  the  heart  reflex  the  following  results  were 
obtained : 

METHOD        AMPLITUDE  OF  REFLEX   DURATION  OF  REFLEX 

Stretching  neck  (Fig.  65)  2.6  cm.  2  min.,  10  sec. 
Concussion  of  yth  cervical 

spine  1.6  cm.  i  min.,  35  sec. 
Cutaneous  irritation  of 

precordial  region  1.6  cm.  i  min.,  10  sec. 

Rhythmic  traction  of  tongue  3.6  cm,  4  min.,  30  sec. 

The  observations  of  Fliess  (page  463),  demonstrated  the 
intimate  relation  existing  between  the  nasal  mucosa  (locus 
genitalis)  and  the  uterine  reflexes. 

Denslow,  quoting  the  observations  of  Otis,  demonstrated 

636 


R     e    f    I     e     x     o     therapy 

a  multitude  of  reflex  symptoms  (paraplegia,  epilepsy,  mental 
confusion),  evoked  by  irritable  lesions  of  the  urethra. 

Certain  forms  of  rhinitis  are  associated  with  hemorrhoids 
and  treatment  of  the  former  condition  has  cured  the  latter 
(Jaworski). 

Bonnier  compares  the  nasal  mucosa  to  a  piano  in  which 
one  can  find  reflexogenic  keys  for  the  entire  organism. 

If  one  has  carefully  studied  chapter  xin,  the  foregoing 
statement  will  not  be  regarded  as  an  hyperbole  insomuch  as 
there  are  many  authentic  case-records  showing  the  cure  of 
many  symptoms  (vertigo,  dyspepsia,  gastralgia,  asthma,  etc.) 
by  appropriate  treatment  directed  exclusively  to  the  nasal 
mucosa.  The  latter  consists  essentially  of  cauterization  of  a 
definite  reflexogenic  point  in  the  mucosa  at  intervals  of  8 
or  10  days. 

Perhaps  the  most  interesting  development  of  reflex- 
otherapy  as  employed  by  Denslow,  Jaworski,  Romero  and 
others,  concerns  the  treatmen^of  locomotor  ataxia. 

Denslow  first  directed  attention  to  the  intimate  relation 
existing  between  the  urethra  and  tabes  and  created  in  conse- 
quence his  method  of  treatment  by  dilatation. 

The  latter  has  been  confirmed  by  a  number  of  enthus- 
iastic observers,  notably  Jaworski.  The  latter,  while  re- 
garding syphilis  as  a  prerequisite  of  tabes,  conceives  it  only 
as  a  predisposing  cause,  and  that  some  peripheric  irritation 
(notably  urethral),  causes  a  primary  enfeeblement  of  the 
roots  of  the  posterior  spinal  nerves. 

The  nature  of  the  urethral  lesions  has  not  been  definitely 
established  but  they  correspond  to  the  lesions  of  herpes 
zoster.  They  are  identified  with  the  lesions  of  the  nasal 
mucosa.  One  frequently  finds  on  examination  of  the  urethra, 
painful  elastic  or  spasmodic  strictures.  The  latter  may  also 
cause  a  variety  of  reflex  phenomena,  notably,  neurasthenia 

637 


Spondyloth     e    r    a    p    y 

and  asthma.  It  has  been  shown  that  any  irritation  of  these 
strictures  will  accentuate  tabetic  symptoms.  Treatment  of 
the  strictures  by  a  meatatomy  and  dilatation  of  the  urethra 
by  sounds,  does  not  cure  tabes,  but  merely  arrests  those 
symptoms  dependent  on  the  urethral  source  of  irritation.* 

The  rectum  is  likewise  a  prolific  reflexogenic  territory. 
Louis  XIV  suffered  from  a  fistula,  and  his  reign  was  said  to 
have  been  divided  into  two  parts — that  before  and  that  after 
the  fistula.  Some  one  has  said  that  the  chief  function  of  the 
consultant  was  to  examine  the  rectum,  insomuch  as  it  is  often 
overlooked  in  our  examinations.  "More  mistakes  are  made 
by  want^of  looking  than  by  want  of  knowing."  I  recall  a 
patient  entrusted  to  me  by  an  eminent  colleague  during  his 
absence  in  Europe.  He  said,  "The  patient  has  a  gastric 
cancer  and  all  you  can  do  is  to  relieve  her  incessant  vomiting. 
For  some  reason,  the  rectum  was  examined  and  after  the 
removal  of  an  enormous  scybalum,  recovery  was  immediate. 

Before  me  as  I  write,  is  a  resume  of  cases  treated  for 
rectal  diseases  by  my  friend  Dr.  W.  T.  Baird,  of  El  Paso,  and 
presented  as  a  report  to  the  Surgeon-General. 

In  85  per  cent  of  the  patients,  soliciting  treatment  for 
various  "reflexes,"  there  was  no  knowledge  of  any  rectal 
disease  and  only  15  per  cent,  of  the  patients  complained  of 
local  or  regional  symptoms.  The  reflex  symptoms  embraced 
practically  every  viscus  and  were  made  up  of  symptomatic 
pictures  ranging  from  neurasthenia  and  constipation  to 
rheumatism  and  cardiac  disease. 

The  most  frequent  lesion  was  ulcer ation  of  the  rectum  and 
treatment  of  the  latter  usually  resulted  in  complete  recovery. 


*Those  desirous  of  pursuing  a  further  study  of  this  subject  should  consult:  "Uti 
nowueau  traitement  du  Tabes;"  Jaworski,  and  "La  reflexotherapie  dans  le  Tabes, 
et  dans  d'autres  Maladies;"  Romero. 

638 


R     e   f    I    e     x     o     t     h      e     r    a     p     y 

The  following  is  an  extract*  of  a  communication  to 
the  "Congress  of  Medicine,"  at  Lyons,  (October  10, 1911), 
by  Dr.  H.  Jaworski,  of  the  Faculty  of  Medicine,  of  Paris: 

"When  confronted  with  symptoms  or  lesions,  one  is 
no  longer  permitted  to  forget  their  remote  effects  (reflex- 
opathy) . 

Without  wishing  to  systematize  to  extremes,  nor  to 
say  that  all  symptoms  are  reflexes,  it  is  nevertheless 
certain  that  the  reflexes  play  a  primary  role  in  the  bio- 
logic mechanism  and  that,  when  properly  employed,  they 
conduce  to  useful  reactions  (r eflexotherapy] . 

Some  of  the  reflexes  are  very  complex  and  different 
lesions  may  provoke  identical  symptoms  (asthma,  epi- 
lepsy). 

From  a  practical  view-point,  the  following  may  be 
regarded  as  the  chief  reflexotherapeutic  methods: 

1.  LINGUAL  REFLEXOTHERAPY  (Laborde),  consists  o' 
rhythmic  traction  of  the  tongue  to  excite  respiratory  and 
cardiac  action. 

2.  URETHRAL  REFLEXOTHERAPY  (Denslow),  consists 
of  rapid  dilatation  of  the  urethra,  which  may  be  reflexly 
utilized  in  the  treatment  of  tabes.    It  is  the  most  rapid 
and  efficacious  treatment  in  the  latter  malady.    After  a 
few  seances,  the  tabetic  experiences  a  strong  sensation 
of  warmth  in  the  feet,  the  deep  sensibility  reappears, 
gait  is  ameliorated  and,  after  a  variable  period  of  time, 
there  is  a  disappearance  of  the  pains  and  symptom  of 
Romberg. 

3.  NASAL   REFLEXOTHERAPY    (Fliess,   Bonnier),   is 
based  on  the  existence  of  localized  reflexogenic  centers 
in  the  nose,  which  after  cauterization  influence  favorably, 
enteritis,  hemorrhoids,  constipation,  asthma  and  men- 
strual affections. 

4.  VERTEBRAL  REFLEXOTHERAPY  (Abrams),  consists 
of  percussion  of  the  seventh  cervical  spine  to  provoke 
reflex  contractions  of  the  aorta  and  other  vessels  con- 
ducing to  the  cure  of  aneurysms. 

^Literal  translation. 

639 


Spondyloth     e    r    a    p    y 

Reflexotherapy  has  been  adequately  demonstrated. 
The  means  employed  are  simple  and  without  danger." 

SPONDYLOTHERAPY  IN  THE  ETIOLOGY  OF  DISEASE. 

One  frequently  encounters  patients  who  are  really  suf- 
fering from  the  effects  of  drugs  given  for  therapeutic  pur- 
poses, and  one  is  constrained  to  recall  a  quotation  from 
Vergilius,  "And  he  becomes  worse  from  the  very  remedies 
used"  (aegrescitque  medendo).  This  therapeutic  overaction 
is  likewise  encountered  in  the  employment  of  spondylo- 
therapy. 

It  must  be  evident  to  the  reader  that  spondylotherapy  is 
essentially  a  treatment  in  which  reflexes  are  employed  to 
achieve  definite  results  (page  392)  and,  in  the  elicitation  of 
one  reflex,  one  may  jeopardise  its  counter-reflex  (foot-note, 
page  147)  and  thus  evoke  a  syndrome  quite  at  variance  with 
the  initial  symptomatic  picture. 

This  spondylotherapeutic  overaction  has  been  referred  to 
in  discussing  the  treatment  of  myocardial  disease  (page  514). 

If  one  judiciously  supervises  treatment,  danger  may  be 
avoided.  Thus,  if  the  test  for  heart-sufficiency  (page  510), 
demonstrates  that  the  object  has  been  accomplished,  further 
treatment  is  not  only  unnecessary  but  even  dangerous. 

In  diseases  dependent  on  deficient  vagal-tone,  the  tests 
cited  on  page  470,  will  show  when  such  tone  is  restored. 

A  patient  with  an  aneurysm  of  the  thoracic  aorta  and 
cured  of  the  latter,  developed  pulmonary  tuberculosis  several 
months  later.  The  treatment  employed  was  concussion  of 
the  7th  cervical  spine  which  likewise  evokes  anemia  of  the 
lungs  (page  604).  It  is  not  unlikely  that  the  diminished 
vascularity  of  the  lungs  contributed  to  tuberculous  infection. 
Of  course,  this  is  only  a  surmise  on  my  part. 

Treatment  by  concussion  of  the  same  spinous  process  in 

640 


S  p    o    n    d    y    I    o     t    h     e    r    a    p    y 

a  cardiaopath  and  in  another  aneurysmal  patient,  eventuated 
in  anasarcous  symptoms.  The  treatment  employed  likewise 
diminishes  the  supply  of  blood  to  the  kidneys  and  thus  com- 
promised the  functions  of  the  latter  (page  634). 

In  both  instances,  the  symptoms  subsided  after  concussion 
of  the  loth  dorsal  spine  for  reasons  already  cited  on  page  617. 
It  is  quite  probable  that,  dilatation  of  the  heart  and  aorta 
consecutive  to  concussion  of  the  zoth  dorsal  spine  is  essen- 
tially a  reflex  of  accommodation  (vascular  reflex)  as  cited  on 
page  519,  and  that  dilatation  of  these  structures  consecutive 
to  concussion  of  the  3d  and  4th  dorsal  spines  is  a  true  par- 
enchymatous  reflex  (page  474). 

In  concluding  this  subject,  attention  must  again  be  di- 
rected to  the  failure  of  a  reflex  responding  to  one  method  of 
excitation,  thus  necessitating  the  employment  of  another 
physio-  or  pharmaco-therapeutic  method  (page  400). 


644 


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Relieves  symptoms  of  splanchnic  neurasthenia  (434) 
lood-vessels. 

Accentuates  symptoms  of  hypertrophic  stenosis  of  t 
Relieves  spasm  of  the  cardia  and  its  concomitant  gasti 

Dissipates  dullness  caused  by  lung-atelectasis  (301). 

.  Augments  symptoms  of  a  dilated  aorta  and  /tear*  du 
structures  (520).  2.  Rales  of  Asthma  inhibited.  3. 
abdominal  congestion.  4.  Pains  of  vagal  origin  reli( 
(brief  seance  of  concussion).  6.  Increases  symptor 
opia,  amblyopia,  nervous  deafness). 

.  Concussion  of  these  vertebrae  diminishes  an  area  o 
gall-bladder. 

If  pyloric  obstruction  is  present  and  pylorus  fails  t 
f  the  pyloric  region  and  possibly  hypertrophic  stenosii 

Pains  of  a  distended  capsule  of  the  kidney  suggestin 
nd  decrease  by  concussing  12  D.  spine  which  diminisl 

Failure  of  the  gall-bladder  to  dilate  suggests  a 
holelithlasis.  Vide,  law  of  Courvoisier  (599). 

.  1.  Accentuates  aneurysmal  symptoms  and  augments 
2.  Cardiac  and  functional  murmurs  due  to  cardiosj 
and  pulmonary  artery  evanesce.  3,  Accentuates 
neuroses  of  dilatation. 
.  Augments  symptoms  of  plethora. 
.  The  degree  of  increase  of  the  kidney-volume  suggest 
supply  (629). 
.  Percussion  of  the  duodenum.  Dull  area  of  the  latt< 
concussion  of  llth  D.  spine  nor  upward  by  pressure 
as  is  the  case  with  the  stomach. 

Growths  or  painful  points  connected  with  stomach 

Percussion  of  A,  facilitated.  Contractility  of  B,  d< 

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SPONDYLOTHER  APY  —  (continued). 

Splanchnic  neurasthenia  (434).  Relief  of  intra-abd 

Cardiotonic  angina  pectoris  (542),  Hypertension  (461} 
ma  (hypertonic  form),  Enuresis  (502),  nervous  affectiol 
thenopia)  and  ear,  when  caused  by  vagus-hypertoi 
mptoms  caused  by  vagal-hyperesthesia  (neuroses  of 
id  intestines). 

Pulmonary  atelectasis  and  to  maintain  the  "open  lun 
children)  in  whom  there  is  a  tendency  to  develop  broncl 
:  areas. 

Catarrhal  jaundice  and  in  infectious  cholecystitis  (for 

Pylorospasm. 

i.  Chlorosis,  by  counteracting  hypoplasia  (605). 
Vasoconstrictor  neuroses, 
i.  Anemia  (by  increasing  number  of  red  blood  corp 
i.  Bright'  s  disease.  2.  Locomotor  ataxia  (616). 

Microgastria,  Spastic  Constipation,  Cirrhosis  of  the 

Prostatic  hypertrophy  (635). 

Gastrectasis  and  dyspepsia  due  motor  insufficiency  of 
Constipation  (328);  3.  Hepatic  congestion;  4.  Spleno: 
of  the  uterus,  uterine  pseudo-fibromata  (419),  hemorr: 
abnormal  positions  of  the  uterus  caused  by  relaxed  ': 

Atonic  conditions  of  the  bladder  caused  by  insumcl 
the  bladder. 

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C  TABLE  OF  PHARMACOLOGY  OF  THE 

CONCERNED  WITH  THE  REFLEXES  CREATED  BY  IRRITABILITY  OF  THE 
'TER  ARE  IN  PHYSIOLOGIC  ANTAGONISM.  .  SYMPTOMS  OR  DISEASES  DU 

irpin  AND  AMELIORATED  BY  adrenalin  AND  atropin.  SYMPTOMS  OR  ] 
;  ACCENTUATED  BY  adrenalin  AND  AMELIORATED  BY  pilocarpin. 

ISH  VAGUS-TONE. 
!  DEMONSTRATED  BY  THE  METHODS  CITED  ON  PAGE  470. 
,  IS  CLOSELY  RELATED  TO  SYMPATHETIC  IRRITATION.  f*Y  THE  FOLLOW 
:  OF  THE  SYMPATHETIC  SYSTEM:  IN  THK  NORM,  INSTILLATION  OF  A  DR( 
0  THE  EYE  HAS  NO  EFFECT  ON  THE  DILATOR  PUPILLAE  (452),  BUT  IN  E: 

nydriasis  ENSUES. 

PIC  TABLE  SUGGESTS  VAGOTROi^C  OK  SYMPATmOCKTROPIC  MEDICATIO: 
HE  VAGAL-REFLEXES  IS  GIVEN  IN  DOSES  OF  tf,  GRAIN  HYPODERMATICA] 
EXES  AND  DIMINISHES  THE  VAGAL-REFLEXES,  IS  ADMINISTERED  SIMIL/ 
PARALYZES  THE  MOTOR  ENDINGS  OF  THE  VAGUS,  IS  GIVEN  HYPODER] 
REFER  TO  THE  PAGES  IN  SPONDYLOTHERAPY  WHERE  THE  PARTICULA 

PHARMACOLOGY  OF  THE  VISCERAL  REFLI 

Atropin  abolishes  and  pilocarpin  accentuates  it.  Bradycardia  a 
or  reflex  excitation  of  the  vagus  are  inhibited  by  atropin.  This  is 
form  of  angina  pectoris  (455).  Strophanthin  by  intravenous  inj 
medicament  for  exciting  the  cardiac  branches  of  the  vagus. 
In  cardiotonic  angina  pectoris,  the  symptoms  are  accentuati 
but  ameliorated  by  atropin  which  intensifies  the  symptoms  of  the 
diodynia  (cardiac  pain)  in  neurotics  is  inhibited  by  inhalations  of 

Contracted  by  pilocarpin  (457),  dilated  by  adrenalin  (457)  and  t 
by  atropin. 

A.  In  arteriosclerosis,  spasm  of  the  vessels  (angiospasm)  is  not  infi 
bral  vessels,  the  spasm  may  cause  transient  attacks  of  vertigo, 
plegia.  Implicating  the  splanchnic  vessels,  there  are  abdomim 
lameness  (claudication)  ;  and  the  crises  of  locomotor  ataxia  are 
(616).  Amyl  nitrite  inhalations  inhibit  the  majority  of  these 
thrice  daily)  is  practically  a  specific  in  arterio  sclerotic  abdomir 
by  vagus-hypertonia  the  thyroids  yield  excellent  results. 
B.  Digitalin  or  strophanthin,  is  endowed  with  the  property  of  con; 
alone.  Chromium  sulphate,  (8  grains  after  each  meal  in  tablet 
author,  one  of  the  most  efficient  agents  for  constricting  the  spl 
indicated  in  splanchnic  neurasthenia  (345,  427). 

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OF  THE  VISCERAL  REFLEXES  —  (continued). 

action.  Atropin  abolishes  them,  pilocarpin  exag§ 
lung  reflex  of  contraction  (456),  Asthma,  is  caused 
rue  of  spasmodic  bronchostenosis  (311).  Adrenalin 
ial  affections  (314).  Nasal  sprays  (310)  which  reliev 
contraction.  Emphysema  caused  by  vagus-hype 
:as  the  atonic  form  of  the  affection  is  ameliorated. 

/>in  abolishes  the  stomach  reflexes.  The  motor  nei 
;o  an  adequate  dose  of  atropin,  whereas  pilocarpin 
y  dilating  the  stomach  accentuates  the  symptoms  of 
,s  caused  by  vagus-hyperesthesia. 

intensifies  intestinal  peristalsis.  Many  affections 
ncreased  or  diminished  tone  of  the  vagus  (496). 

s-stimulation  (497).  Symptoms  arising  from  eye-sti 
r  cent,  solution).  Homatropin  and  atropin,  do  n 

renter  and  must  be  examined  as  a  routine  measure  in 
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labor  and  gastric  pains  (464).  Temporary  relief  of 
i  perhaps  permanent  relief  by  cauterization  of  susc 

IS 

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dysmenorrhea  (463),  , 
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a    p    y 


SPONDYLOTHERAPEUTIC  ARMAMENTARIUM* 


This  hammer  for  evoking  the  vertebral  reflexes  (page  7),  is  called 
after  the  French  neurologist,  plexor  of  Dejerine.  Although  employed 
chiefly  for  diagnostic  purposes,  it  may  substitute  a  concussion-ap- 
paratus in  spondylotherapy.  Indeed,  many  physicians  have  used 
the  plexor  exclusively  to  attain  their  therapeutic  results.  The  rubber 
affixed  to  the  plexor  is  chiefly  designed  to  give  resiliency  to  the  blow, 
an  important  desideratum  in  the  elicitation  of  the  reflexes. 

This  pleximeter  of  metal,  covered  at  one  end  with  rubber,  is 
employed  concurrently  with  the  plexor  as  shown  in  Fig.  2. 


*The     illustrated    spondylotherapeutic    apparatus    is    purchasable  from  The 
Philopolis  Press,   406  Lincoln  Building,   San  Francisco. 

648 


Spondylo therapeutic     Armamentarium 


The  instrument  with  a  single  prong  (Algesispondyloscope),  is  used 
for  demonstrating  areas  of  paravertebral  tenderness  (page  66). 

The  instrument  with  two  prongs  (radicularpressor),  is  employed 
for  making  bilateral  pressure  on  the  roots  of  the  spinal  nerves  at 
their  exit  from  the  intervertebral  foramina. 

The  employment  of  pressure  in  treatment  (which  I  shall  neologize 
as  barotherapy)  has  been  discussed  on  page  169,  and  reference  to  its 
diagnostic  value  (diagnostic-ba.rothera.py)  has  been  made  on  page 
467,  et  seq. 

The  investigations  of  the  author  with  barotherapy  show  that,  the 
efficacy  of  the  treatment  is  due  to  blocking  of  the  roots  of  the  spinal 
nerves. 


649 


Vibrosuppressor  and  its  application  to  the  chest.  The  value  of 
vibrosuppression  in  diagnosis  is  discussed  on  page  80.  The  cushion 
of  this  instrument  is  provided  with  a  small  metallic  button  so  that 
it  may  also  be  employed  in  barotherapy.  By  removing  the  button, 
the  apparatus  is  used  solely  as  a  vibrosuppressor. 


Spondylotherapeutic    Armamentarium 


Pneumatic  hammer  with  concussors.  This  operates  with  a  pressure 
of  40  pounds  and  yields  a  blow  equivalent  to  12  pounds. 

This  hammer  is  very  efficient  but  because  it  is  noisy  and  com- 
pressed air  is  not  always  available,  the  electro-concussor  of  the  author 
is  preferable. 


651 


Spondylotherapy 


The  author's  Electro-concussor.  This  apparatus  was  constructed 
for  the  purpose  of  securing  percussion-effects  and  the  latter  only. 
Practically  all  the  instruments  designed  for  sismotherapy  are  mere 
vibrators  and  are  absolutely  useless  for  executing  the  methods  of 
spondylotherapy.  This  electro-concussor  is  portable,  and  its  flexible 
shaft  is  readily  attached  to  an  "AC"  or  "DC"  motor.  At  a  slight 
expense,  an  extra  motor  may  be  purchased  and  as  both  motors  are 
interchangeable,  the  apparatus  may  be  used  on  either  current.  It  is 
provided  with  two  concussors  which  deliver  blows  to  both  sides  of 
a  spinous  process.  The  reason  for  the  latter  is  cited  on  page  395. 

652 


Spondylo  therapeutic    A  rmamentarium 


High-frequency  coil  and  double  vacuum  electrode.  This  coil 
delivers  a  high  voltage  and  is  equally  suitable  for  fulguration  and 
ozone  treatment.  The  coil  can  be  instantly  connected  with  any 
lamp  socket  furnishing  100-120  volts  either  direct  or  alternating 
current. 


653 


S  p     o     n     d    y    I    o     t    h 


a    p    y 


This  is  a  complete  sinusoidal  and  galvanic  apparatus.  A  diagnostic 
lamp-current  may  also  be  obtained.  The  selection  of  current  is 
simplified  by  means  of  the  dial  selector  and  any  one  of  the  ten  modali- 
ties may  be  instantly  selected.  The  apparatus  is  constructed  to  be 
operated  with  the  no  volt  direct  current;  but  when  an  alternating 
current  only  is  available,  a  rectifier  is  used  to  change  the  alternating 
into  a  direct  current. 


654 


Sp  o  n  dylo  therapeutic    ^4  rm  amentarium 


This  is  a  simplified  form  of  the  preceding  apparatus  and  delivers 
a  true  sinusoidal  current.  Operated  with  the  direct  current,  this 
apparatus  gives  a  galvanic,  slow  sinusoidal  and  surging  galvanic 
current.  Operated  with  no-volt  alternating  current,  it  yields  a  fast 
and  slow  sinusoidal  current,  surging  wave  and  alternating  current. 


655 


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660 


Index 


Index 


Abdomen,  pendulous  and  backache,  87. 
Abdominal  insufficiency,  145,  529. 

Kellogg's  method  in,  145. 
Abdominal  organs,   hyperalgesic  zones 

for,  67. 

Abdominal  supporters,  145,  531,  532. 
Acromegaly,  in  diagnosis  of  spinal  de- 
formity, 131. 
Acupuncture,  146. 
Adjustment  of  muscles,  125. 

of  cervical  vertebrae,  125. 
Adrenalin,  451,  590,  607,  613. 
Alar,  or  pterygoid  chest,  the,  94. 
Albuminuria,  632. 

Albuminuria,  orthostatic,  122,  547,  633. 
Algesispondyloscope,  649. 
Amblyopia,  496. 
Amyl  nitrite,  616. 
Anatomic  landmarks,  19. 
Anatomy  of  the  spine,  17. 
Anemia,  pulmonary,  605. 
Aneurysm,  abdominal,  266,  566. 

action  of  drugs  on,  457. 

and  aortic  insufficiency,  552. 

backache  in,  88. 

classification  of,  580. 

definition  of,  550. 

dilatation  of,  474. 

etiology  of,  551. 

in  spinal  deformity,  131. 

murmurs  of,  527. 

of  innominate,  578. 

of  pulmonary  artery,  565. 

radio-diagnosis  of,  561. 

rationale   of  treatment,   409,    518, 
581- 

relation  to  other  diseases,  500. 

reports  of  cases,  569,  572,  574,  578. 

statistics  of,  551. 

symptoms  of,  553. 

thoracic,  254. 

treatment  of,  257,  568. 
Aneurysm,  thoracic,  254. 

heart- reflex  in  diagnosis  of,  210. 

treatment  of,  257. 
Anesthesia,     simulated,     in     litigation 

backs,  98. 
hysterical,  414. 

Angina  pectoris,  221,  455,  539,  542. 
Allen  Burns'  theory  of,  221. 
digitalis  may  provoke,  225. 
factors  exciting,  221. 
false,  194. 


Angina  pectoris,  continued 

false,  differentiation  of,  224. 

heart-reflex    in    differentiation    of 
false,  223. 

Mackenzie's  concept  of,  73. 

spinal  concussion  in,  223. 

spinal  element  in,  73. 

treatment  of,  226. 

true,  differentiation  of,  224. 
Anginoid  pains,  540. 
Angio-ataxia,  276. 
Angio-neuroses,  visceral,  276. 
Angio-paralysis,  276,  277. 
Angio-paralytic  affections,  278. 
Angio-paralytic  neuroses,  concussion  in, 

286. 

Angio-spasm,  275,  277. 
Angio-spastic  affections,  277. 
Angular  curvature,  117. 
Ankylosis,  579. 
Anoxemia,  606. 
Aorta,  abdominal  reflex  of,  265. 

dilatation  of,  550. 

fluoroscopy  of,  561. 

percussion  of,  558. 
Aortarctia,  525. 
Aortectasis,  525,  551,  620. 
Aortograms,  567. 
Aortoptosis,  561,  568. 
Aorta,  spinal  concussion  dilates,  255. 

spinal  concussion  contracts,  256. 
Aortic   reflex   of   contraction   in   treat- 
ment, 257. 
Aortic  reflexes,  the,  254. 

elicitation  of,  279. 

in  diagnosis,  256,  577. 

physiology  of,  266-267. 
Aphonia,  differential  diagnosis  of,  190. 
Appendicitis,  chronic,  and  backache,  88- 
Appendicitis,  pseudo,  191. 
Arterioslerosis,  abdominal,  567. 
Arterio-sclerotics,  classes  of,  242. 
Arrhythmia,  nasal,  463. 

pseudo,  195. 

Arthritis  deformans,  401,  579. 
Asthenopia,  496. 
Asthma,  bronchial,  303,  494. 

adrenalin  in  treatment  of,  314. 

amyl  nitrite  in,  309. 

concussion  in,  313. 

differential  diagnosis  of,  312. 
Asthma,  cardiac,  212. 

treated  by  spinal  concussion,  220. 


663 


S  p    o     n     d    y     I    o     t    h     e     r    a    p    y 


Asthma,  differentiation  of,  212. 

lung  reflex  of  dilation  in  diagnosis, 
297. 

lung  reflex  of  contraction  in  treat- 
ment, 299. 

nasal,  462. 

Nathan  Tucker  remedy  in,  309 
and  other  diseases,  502. 

pseudo,  495. 

sinusoidal  current  in,  313. 

theories  of  cause,  306. 

tracheal  traction,  test  of,  311. 
Asthma,  treatment  of,  312. 
Atropin,  action  on  vagus,  453. 

in  diagnosis,  454. 
Auscultation,  pulmonary,  494. 
Auto-intoxication,  intestinal,  335. 
Autonomic  system,  411,  426,  450. 
Auto-transfusion,  610. 


Babinski  reflex,  15,  16. 

Schneider's  explanation  of,  15. 
Babinski  syndrome,  552. 
Backache,  53,  83. 

associated    with    indurative    head- 
aches, 89. 

exclusion  of  kidney  factors  in,  83. 

in  women,  causes  of,  84. 

lumbago,  and,  84. 
Backache,  factors  in: 

acute  infections,  89. 

aneurysm  of  thoracic  aorta,  88. 

constipation,  84. 

chronic  appendicitis,  88. 

chronic  periostitis,  87. 

deformity  of  ribs,  91. 

faulty  breathing,  85. 

floating  kidney,  91. 

from  foot  disability,  421. 

gastric  tympanites,  84. 

improper  dress,  89. 

over  distended  seminal  vesicles,  87. 

pelvic  disease,  88. 

pendulous  abdomen,  87. 

post-operative,  87,  93. 

prostatic  disease,  87. 
Backaches,  sacro-iliac,  in  women,  112. 

professional,  93. 

special,  93. 

synoptic  table  of,  91. 
Backs,  litigation,  97. 
Barotherapy,  649. 
Basedow's     disease,     accentuated     by 

drugs,  458. 
Beevor's  sign,  136. 


Beri-Beri,  406. 
Blistering,  150. 
Bladder  reflex,  the,  358. 
Blood-pressure: 

causes  of  high,  241. 

drugs  lowering,  247 

in  diagnosis,  235. 

in  surgery,  238. 

in  testing  heart  sufficiency,  241. 

in  typhoid  fever,  238. 

low,  250. 

pathology  of,  232. 

physiology  of,  232. 

treatment  of  high,  237,  461. 

vaco-motor  factor  in,  239. 
Bibliography,  657. 
Blood-corpuscles,  617. 
Blood-vessels,  pathologic  physiology  of, 
232. 

physiology  of,  231. 
Blood-volume,  617. 
Boat-shaped  chest,  the,  94. 
Bone-sensibility,  in  vertebral  pain,  67. 
Bradycardia,  454. 
Brain,  sinusoidalization  of  the,  383. 
Bright's  disease,    spinal   concussion   in 

treatment  of,  361,  632. 
Bromids,  in  diagnosis,  460. 
Bronchial  asthma,  303. 

factors  of,  303-304. 

Bronchial  glands  enlarged,  Grancher's 
sign,  82. 

Petruschky's  sign,  82,  622. 
Bronchial  phthisis,  vertebral  percussion 
in,  80. 


Calcimeter,  613. 
Calcium  lactate,  633. 
Cardiectatic  angina  pectoris,  543. 
Cardioptosis,  529. 
Cardiospasm,  589. 

Cardio-splanchnic  phenomenon,  346. 
Catalase  test,  513. 
Cecum,  mobile,  595. 
Celiac  axis,  567. 
Cell-stimulation,  400. 
Cervical  plexus,  51. 

Cerebral    arterio-sclerosis,    spinal    con- 
cussion in,  250. 
Cervical  caries,  attitude  in,  96. 

mal-alignment,  123. 

adjustment,  125. 
Cervical  rib  of  Hunauld,  94. 
Change  of  life,  toxic  conditions  in,  286. 
Chassaignac's  tubercle,  21. 
Chest,  defective  expansion  of,  300. 


664 


n 


d 


x 


Chest  deformities,  94. 

pains,  545. 

Chiropractic,  5,  6,  388. 
Chloro-anemia,  605. 
Chlorosis,  605. 
Cholelithiasis,  pseudo,  197. 
Chromaffin  system,  451. 
Chromium  sulphate,  635. 
Circulation,  splanchnic,  427. 

system,  510. 

Claudication,  tibial  artery  test  for,  225. 
Clinical  observations,  psychology  of,  267. 

pharmacology,  504. 
Cocain   anesthesia,    in   diagnosis,    464, 

582- 

Cocain  solution  for  excluding  rectal  fis- 
sure in  backache,  87. 
Cocain  test,  in  lung  reflex  of  dilatation, 

297. 
Coccygodynia,  95. 

Graefe's  method  of  treatment  of, 

95- 
Cold,  action  of,  544. 

application  of  in  abdominal  affec- 
tions, 60. 

Cold  applications  to  spine,  167,  172. 
Cold  extremities,  concussion  in,  285. 
Collodion,  in  the  cure  of  persistent  mu- 
cous abrasions,  77. 
Colon,  percussion  of,  592. 
Compression  myelitis,  and  spinal  pain, 
128. 

causes  of,  133. 

symptoms  of,  133. 
Concussion,  spinal: 

in  abdominal  aneurysm,  262. 

in  angio-paralytic  neuroses,  285. 

in  cold  extremities,  285. 

in  coryza,  284. 

in  diabetes,  281. 

in  diagnosis  of  malaria,  354. 
Concussion,  spinal: 

in  diagnosis  of  typhoid  fever,  356. 

in  digestion-intoxication,  285. 

in  excitation   of  vertebral  reflexes, 
8,  9,  10. 

in  exophthalmic  goitre,  280. 

in  migraine,  280. 

in  hypotension,  249,  253. 

in  thoracic  aneurysm,  257,  262. 

in  the  vaso-motor  neuroses,  279. 

in  vascular  hypertension,  248. 

more  effective  than  vibration,  176. 

physiology  of,  380. 

slow  and  rapid,  396. 

therapeutics  of,  394,  409. 
Concussors,  177. 


Congestion  of  spinal  cord,  126. 
Constipation,  327. 

a  factor  in  backache,  84. 

atonic,  328. 

Cooper's  test  of,  328. 

spastic,  328. 

treatment  of,  329. 
Cooper's  table  of  backaches,  91. 
Coryza,  concussion  in,  284. 
Coughs,  elicitation  of  reflex,  77. 

inhibited  by  freezing,  77. 
Courvoisier,  law  of,  599. 
Counter-irritation,  for  pain,  148. 

areas  for,  148,  149. 

Cranial  nerves,  reflexes  of,  440,  et  seq. 
Cupping,  149. 

Cutaneous  areas  for  influencing  viscera, 
174. 

Dam-sign,  559. 
Dana,  7,  56. 
Depressor  nerve,  469. 
Dermographism,  277. 
Dermatomes  of  Head,  58. 

elicitation  of,  60. 
D'Espine,  sign  of,  623. 
Diabetes  mellitus,  281,  479,  507. 

concussion  treatment  of,  283. 
Diet: 

antiputrid  regime,  341. 

in  intestinal  auto-intoxication,  341. 

in  uric  acid  diseases,  102. 

Metchnikoff's     lactic     acid     anti- 

microbic,  344. 
Diaphragm,  reflex  of,  550. 
Diathermic  spondylotherapy,  404. 
Digestion-intoxication,  286. 

concussion  treatment  of,  287. 
Digitalis,  512,  520. 

and  diuretin,  513,  521. 
Diuretin,  513. 

Drugs,  action  on  vagus,  505,  509. 
Drummond,  sign  of,  556. 
Duodenum,  percussion  of,  592. 

ulcer  of,  595,  596. 
Dysmenorrhea,  463. 
Dyspepsia,  pseudo,  197. 
Dysphagia,  473. 

Edema,  632. 

Electric  concussion-hammer,  179. 

Electric  massage  apparatus,  101. 

nerves,  583. 
Electro-concussor,  652, 
Electro-therapy,  151. 
Electro-thermal  pads,  175. 
Emaciation,  492. 


665 


Spondyloth     e    r    a    p    y 


Emphysema,  sinusoidalization  in,  315, 

495- 

Enuresis,  502. 

Esophagismus,  196,  496. 

Ether  anesthesia  in  osteoaithritis,  108. 

Examination  of  the  spine: 
cold  air  current  in,  69. 
elicitation  of  localized  spasm  in,  78 
elicitation  of  vertebral  tenderness, 

?6,  77- 

Faradic  current  in,  69. 

freezing  in,  76,  77. 

for  deformity,  44. 

for    eliciting    the    dermatomes    of 
Head,  6p. 

for  flexibility,  41. 

for  Head's  dermatomes,  72. 

for  rigidity,  46. 

for  rotation,  44,  45. 

for  spasm,  47. 

for  vertebral  pain,  66. 

of  muscular  force,  53 

tuning-fork  in,  67. 

spondylotherapy,  43. 
Exercises: 

for  lateral  curvature,  161. 

for  round  shoulders,  160. 

Fraenkel's,  in  tabes,  165. 

spondylotherapeutic,  160. 
Exophthalmic  goitre: 

pseudo,  485. 

Spinal  concussion  in,  281. 

theory  of,  280. 

tracings  of,  493. 

treatment  of,  490. 

quinin  in,  505. 
Exophthalmos,  490. 
Eye,  441. 

innervation  of,  441. 

reflexes  of,  443,  498. 

signs  in  hyperthyroidism,  487. 
Eye-strain  as  a  cause  of  spinal  deformi- 
ties, 124. 


Faradic  current,  in  coccygodynia,  96. 
for  finding  painful  centers,  68. 

Faulty  attitudes,  96. 

Faulty  breathing   as  a  factor  in  back- 
ache, 85. 

Fetal    rickets    in    diagnosis    of    spinal 
deformity,  131. 

Fever,  390. 

Fibrolysin  in  osteo-arthritis,   108. 

Fibrositis,  422. 

Flat-back,  96. 

Flat-foot,  422. 


Freezing,  in  diagnosis,  188,  548. 

in  intercostal  neuralgia,  187. 

in  spondylotherapy,    76,    77,    150, 
172. 

in  treatment  of  pain,  375. 

physiology  of,  381. 

reinforced,  173. 
Fraenkel's  exercises  in  locomotor  ataxia, 

165. 
Functional  murmurs,  525. 


Gall-bladder: 

diseases  of,  590,  599,  600. 

influenced  by  concussion,  599. 

location  of,  597. 

Garrigues'  classification  of  pelvic  back- 
aches, 89. 
Gastrectasis,  588. 
Gastric  ulcer,  454. 
Gastroptosis,  589. 

Gibbert's  syrup  in  syphilis  of  bones,  140. 
Glenard's  disease,  349,  529. 
Glycosuria,  479. 
Goitre,  492. 

Gonococcic  vaccine,  141 
Gonorrhoea  of  bones,  141. 

Fuller's  treatment  of,  141. 
Gout,  spinal  phenomena  in,  76. 

control  of  pain  by  freezing,  76. 
Gowers,  quoted,  i. 
Graefe's  sign,  487. 
Griffin  Brothers,  2. 
Grocco,  triangles  of,  606,  608. 
Gymnasts,  Swedish,  4. 


Hall,  Marshall,  4. 
Head's  dermatomes,  7,  58. 
Head,  dermatomes  of,  58. 

iailure  to  elicit,  71. 

Head,  painful  areas  of,  in  visceral  dis- 
ease, 64,  65. 
Headache,  indurative  of  Edinger,  and 

backache,  89. 

Hearing,  disturbances  of,  498. 
Heart: 

block,  454. 

failure,  523. 

functional  affections  of,  228. 

further  advances  in  treatment,  510 

hypertrophy  of,  211. 

incompensation  of,  210. 

inhibition  of,  228,  528. 

insufficiency  of,  210,  213,  510. 

murmurs,  525,  528. 

nerves,  518,  521. 


666 


n 


d 


Heart,  continued 

percussion,  471. 

tonicity  of,  517. 

valvular  lesions  of,  211. 
Heart  disease,  dyspnea  in,  212. 

heart-reflex,  a  guide  in  prognosis 

of,  214. 
Heart   insufficiency,   spinal   concussion 

in,  219. 
Heart  reflex,  199,  511,  512,  514,  636. 

a  guide  to  prognosis  in  myocardial 
disease,  214. 

amplitude  of,  227. 

atropin  on,  454. 

elicitation  of,  201. 

in  pericardial  effusion,  209. 

in  valvular  insufficiency,  209. 

method  for  testing  heart-sufficiency, 
217. 

method  of  determining  amplitude 
of,  215. 

mucous  membranes,  and,  202. 

myopathic,  202. 

of  dilatation,  221,.  519. 

of  gastric  genesis,  207. 

of  nasal  genesis,  207. 

of  rectal  origin,  207. 

psychic,  203. 

practical  value  of,  204. 

pilocarpin,  on,  454. 

vertebral  concussion,  and,  204. 

Schott  treatment,  a  method  of  pro- 
voking, 210. 
Heart-strain    and    nervous   exhaustion, 

220. 
Heart-sufficiency,  tests  for,  215. 

treatment  of,  213. 

Heart  tonics,  test  for  administering,  242. 
Heat,  application  of  to  spine,  167,  174. 
Hemoptysis,  treatment  of,  315,  616. 
Hemorrhoids,  as  a  factor  in  backache 

and  sciatica,  86. 
Hepatic  toxaemia,  334. 
High-frequency  current,  399. 
Hip-joint    disease,    differentiated   from 

spinal  disease,  128. 
Hollow-back,  96. 
Hormones,  391. 
Hoover's  sign,  136. 
Hulett,  quoted,  4. 
Hunaud's  cervical  rib,  94. 
Hydrotherapy,  i. 

spinal,  166. 
Hyperalgesic     zones,     for     abdominal 

organs,  67. 
Hyperalgesia,  416. 
Hyperemia,  effects  of,  404. 


Hyperesthesia,  vagal,  504. 
Hypertension,  treatment  of,  246,  461. 
Hyperthyroidism,  482,  488. 

cardiac  disturbances  in,  485. 

symptoms  of,  484,  488. 
Hypertrophy  of  prostate,  634,  635. 
Hypotension,  250. 

treatment  of,  252. 
Hypothyroidism,  482. 
Hysteria,  466. 

eye-signs  of,  496. 

hearing  in,  499. 

spine  of,  104. 


Indicanuria,  336. 

demonstration  of  by  sinusoidaliza- 
tion,  336. 

Porter's  test  for,  336. 
Indurated  muscles,  from  strain,  91. 

rheumatic,  90. 
Inhibition  of  heart,  528. 
Insanity,  in  hyperthyroidism,  486. 
Intercostal  neuralgia  as  a  simulator  of 

visceral  disease,  183,  186. 
Intestinal  auto-intoxication,  330. 

treatment  of,  338,  345. 
Intestinal  neuroses,  330. 
Intestinal  reflex,  of  contraction,  325. 

of  dilatation,  326. 
Intestines,  diseases  of,  326,  594. 

percussion  of,  591. 

peristalsis  of,  596. 
Intra-abdominal  insufficiency,  529. 
Intra-spinal  tumors,  diagnosis  of,  129. 
Japanese  method  of  restoring  life,  515. 

Jiu-jitsu,  516. 
Kataphoresis,  582. 
Kellogg's  sinusoidal  apparatus,  154. 
Kelly's  observation  on  pelvic  pain,  88. 
Kidney: 

functional  tests  of,  630. 

percussion  of,  359,  630. 
Kidney  reflexes,  the,  359,  629. 

in  diagnosis  and  treatment,  361. 
Kidney  reflex  of  contraction,  360. 

of  dilatation,  360. 
Kilmer's  belt,  628. 
Klapp's  creeping  exercises,  164. 
Knee-jerk,  14. 

elicitation  of  by  sinusoidalization  in 
locomotor  ataxia,  30. 

In  locomotor  ataxia,  28. 

reflex  arc  of  the,  28. 
Kocher-Boston  sign,  487. 
Kuatsu,  515. 
Kuhn's  mask,  609. 


667 


Spondyloth 


a    p    y 


Kyphosis,  115. 

varieties  of,  116. 

Laborde,  method  636. 

Laborer's  spine,  107. 

Landmarks  of  the  vertebral  spines,  23. 

Laryngeal  stenosis,  414. 

Laryngitis,  190. 

Laryngismus  stridulus,  623,  625. 

Lateral  curvature,  diagnosis  of,  129. 

exercises  for,  161. 
Leduc  current,  399. 
Leukemia  and  spinal  pain,  129. 
Ling's  observations,  4. 
Litigation  backs,  97. 
Liver: 

methods  of  contracting,  435. 
pathologic  physiology  of,  333. 
percussion  of,  596,  598. 
reflexes  of,  331,  332. 
treatment    of    circulatory    disturb- 
ances of,  337. 
Lithiasis,  pseudo,  197. 
Lloyd's  rules,  in  diagnosis  of  muscular 

rigidity  in  Pott's  disease,  no. 
Localization  of  function  in  spinal  seg- 
ments, 30-34. 

Localization  of  the  spinal  nerves,  24. 
Locomotor  ataxia,  differentiation  of  in 

spinal  pain,  130. 
elicitation  of  knee-jerk  in,  by  sinu- 

soidalization,  30. 
Fraenkel's  exercises  in,  165. 
hypotonia  in,  54. 
reflex  arc  in,  28,  29. 
spinal  treatment  of,  363-364,  405, 

616,  637. 
Loewi's  sign,  in  diagnosis  of  sensitive 

areas,  70. 
Lordosis,  115. 

compensatory,  116. 
Lumbago,  diagnosis  of,  84,  99. 

differentiation  of  in  spinal  pain,  129. 
traumatic,  103. 
treatment  of,  100. 
Lumbar  bulging,  differentiation  from 

kyphosis,  117. 
Lumbar  puncture,  167. 
Lumbo-abdominal   neuralgia   mistaken 

for  appendicitis,  192. 
Lung  reflex  of  Abrams,  293. 
of  contraction,  298. 
elicitation  of,  299. 
of  dilatation,  294. 
cocain  test  in,  297. 
diagnostic  value  of,  297. 
drugs  on,  455. 


Lung-border,   methods   of   influencing, 

476. 
Lung-dullness,  postural,  290. 

in  treatment,  293. 
Lungs,  atelectasis  of,  299. 

blood-supply  of,  608. 

edema  of,  524. 

tuberculosis  of,  602,  609,  612. 

Mammary  neoplasms,  pseudo,  198. 

MannkopfPs  sign  in  diagnosis  of  sensi- 
tive areas,  70. 

Mai-alignment  of  cervical  vertebrae, 
123. 

Malaria,  splenic  reflex  in  diagnosis  of, 

354,  5°°- 

in  treatment  of,  355. 
Malignant  disease  in  diagnosis  of  spinal 

deformity,  131. 
Massage,  electric,  in  lumbago,  100. 

spinal,  168. 

vibratory,  175. 

Meningismus,  muscular  rigidity  in,  50. 
Menopause  symptoms,  487. 
Menorrhagia,  486. 
Mesoaortitis,  552. 
Migraine,  nature  of,  280. 

concussion  treatment  of,  280. 
Moros'  test  for  tuberculosis,  139. 
Mucous  colitis,  530. 
Muller's  law,  of  projected  irritation,  73. 
Murmurs: 

aneurysmal,  527. 

heart,  525. 

phthisical,  604. 

subclavian,  533. 

Muscles,  of  the  back,  examination  of, 
46. 

rigidity  of,  46. 

sinusoidalization  of,  157. 
Muscular  conception  of  disease,  n. 

exercises,  46. 

fatigue  in  neurasthenia,  52. 

hypotonia,  52. 

reflexes    12. 

rigidity  in  spinal  disease,  52. 

rigidity  in  thoracic  disease,  420. 

spasms,  417. 

tonus,  409. 
Muscular  ataxia,   spinal   treatment  of, 

363,  364- 
Muscular  paralysis,  sinusoidalization  in 

treatment  of,  362. 
contractures,    sinusoidalization    in, 

362. 

Myistides,  422. 
Myocardial  tone,  test  for,  471. 


668 


n 


d 


x 


Myocarditis: 

differentiation  of,  513,  524. 
symptoms  elicited  by  spinal  con- 
cussion, 74. 


Nasal  anomalies  and  faulty  breathing, 

86. 

Nauheim    treatment    and    the    heart- 
reflex,  210,  218,  409. 
Naunyn  test,  479. 
Neck-affections,  areas  of  referred  pain 

in,  64. 
Nephritis: 

experimental,  632. 

treatment  of,  633. 
Nerves: 

muco-cutaneous,  465. 

specific  cutaneous,  545,  583. 
"Nerve-tracing,"  5. 
Nervous  system: 

divisions  of,  449. 

ocular,  442. 
Neurasthenia  and  heart  strain,  220. 

hypotension  in,  252. 

muscular  fatigue  in,  52. 

splanchnic,  252,  337,.345»  34<5. 

vertebral  tenderness  in,  70. 
Neuralgia,  185. 

intercostal,  186,  546. 

trigeminal,  414. 
Neuralgia  of   spinal  nerves  simulating 

visceral  disease,  182. 
Neuritis,  a  cause  of  vertebral  tenderness, 

73- 

Neuro-mimesis,  in  diagnosis  of  spinal 
pain,  130. 

Neurotic  spine,  103. 

Noguchi's  simplified  .  Wassermann  re- 
action, 140. 

Nose,  as  a  reflex  center,  462,  637,  639. 


Obesity,  heart  failure  in,  524. 

Orthoform,  454. 

Orthoform    ointment    in    diagnosis    of 

hemorrhoidal  backache,  86. 
Orthostatic  albuminuria,  122. 
Osteo-arthritis,   105,  579. 
Osteo-arthritis,  modern  theory  of,  105. 

thymus  extract  in,  106. 

toxaemic,  106. 

vertebral  form  of,  106. 

spinal  deformity,  131. 
Osteo-myelitis  in    diagnosis    of    spinal 

pain,  130. 
Osteopathic  conception  of  disease,  4. 


Osteopathic  traumatism,  121. 
Osteopathy,  4,  387. 

Paget's  disease    and   spinal    deformity, 

132- 
Pain,  55. 

anginoid,  540. 
chest,  545. 
formula  for,  546. 
radicular,  547. 
reflex  phenomena  of,  413. 
visceral,  415. 
Pain,  pelvic,  Kelly's  observation  upon, 

88. 

vertebral,  66;   diagnosis  of,  367. 
segmental  localization,  367-371. 
in  trigeminus  nerve,  371. 
neuralgic,  378. 
visceral  origin,  379. 
therapeutics  of,  365. 
concussion  analgesia,  367. 
infiltration  anesthesia  of  Schleich, 

382. 

hysterical,  378. 
segmental  analgesia  of  the  viscera, 


segmental  psychrotherapy,  375. 

segmental  analgesia  in,  366,  377. 

sinusoidal  analgesia,  374. 

spinal  nerve-trunk  analgesia,  382. 
Painful   areas   about   head  in   visceral 
disease,  64,  65. 

in  affections  of  the  head  and  neck, 

64. 

Painful     spinal     centers,     located     by 
Faradic  current,  69. 

by  cold  air  currents,  69. 
Pains  in  viscera,  reproduced  by  verte- 

bral pressure,  72. 
Pains,  reflex,  56. 
Pains,  transferred,  5,  56. 
Palpation,  transmitted,  416. 
Pancreas,  600. 

activity  of,  600. 
Paradoxic  pulse,  537. 
Parallelogram,  vascular,  606. 
Paralysis  agitans,  attitude  in,  96. 
Paralysis  muscular: 

elicitation  of  contractions  from  the 
spine,  in,  362. 

spinal  concussion  in,  362. 
Paraplegia,  varieties  of,  134. 
Parathyroids,  614. 
Paravertebral  pressure,  467. 
Paravertebral  triangles,  606,  608. 
Paravertebral  tenderness,  437. 
Patellar  reflex,  14. 


669 


S  p 


o     n 


d    y    I 


t     h 


r    a    p    y 


Percussion: 

auscultatory,  560. 
shock,  554. 
threshold,  511. 
Peritoneum,  nerves  of,  416. 
Pertussis,  619. 

and  other  diseases,  501. 
analysis  of  treatment,  627. 
author's  conception  of,  620. 
author's  treatment  of,  627. 
Petit's  triangle,  21. 
Phantom  tumor,  418. 
Pharmacology,  clinical,  504. 
Pharmacologic  methods,  453. 
Phloridzin,  630. 
Phrenic  nerve,  549. 
Phthisis,  602. 

thyroid  in,  459. 

Physiology  of  the  spinal  cord,  26. 
Physiology,  clinical,  388. 
Phylogenetic  diseases,  500. 
Pilocarpin,  451,  522,  590. 
Placebo,  503. 
Plethora,  618. 
Pleurodynia,    in    diagnosis    of    spinal 

pain,  130. 

Pneumatic  hammer,  177. 
Pneumonia,  515. 
Poliomyelitis,  406. 
Post-operative  backache,  87. 
Postural  lung-dullness,  290. 

in  treatment,  293. 
Pott's  disease,  108. 

Pott's  disease  and  spinal  deformity,  132. 
Lloyd's  rules  in,  109. 
localities  of,  109. 
muscular  rigidity  in,  109. 
Pressure,  spinal,  169,  467. 

and  visceral  reflexes,  169,  170. 

at  vertebral  exits  elicits  muscular 

contractions,  48. 
physiology  of,  380. 
points  of  election  for,  171,  473. 
Professional  backache,  93. 
Propinquity,  diseases  of,  502. 
Prostatic  hypertrophy,  634,  635. 
Prostatic  disease  and  backache,  87. 
Pseudo-diseases  and  spondylo-diagnosis, 

182. 

Pseudo-angina  pectoris,  194. 
Pseudo-appendicitis,  191. 
Pseudo-arrhythmia,  195. 
Pseudo-cerebral  disease,  192. 
Pseudo-cholelithiasis,  197. 
Pseudo-dyspepsia,  197. 
Pseudo-esophagismus,  196. 
Pseudo-fibroma,  419. 


Pseudo-hypertrophic  muscular  paralysis. 

attitude  in,  96. 
Pseudo-lithiasis,  197. 
Pseudo-mammary  neoplasms,  198. 
Pseudo-mastoiditis,  193. 
Pseudo-pertussis,  624. 
Pseudo-phthisis,  439. 
Pseudo-visceral     diseases,     explanation 

of,  182,  439. 

Psychology  of  clinical  observations,  267. 
Psychrotherapy,  spinal,   172. 

segmental,  420. 
Psycho-vagus  tone,  466. 
Pulmonary  artery,  reflex  of,  526. 
Pulmonary  atelectasis,  299 

treatment  of,  302-303. 
Pulmonary  anemia,  301,  605. 
Pulmonary  osteoarthropathy  and  spinal 

deformity,  132. 
Pulmonary  suction,  603. 
Pylorospasm,  589,  595. 
Pylorus: 

measurements  of,  588. 

methods  of  contracting  and  dilat- 
ing, 588. 

Quincke's  sympathetic  sensations,  57. 
Quinin,  505,  628. 

Rachialgia,  70. 
Rachitic  chest,  the,  94. 
Radicularpressor,  468. 
Radioscopy  of  the  aorta,  561. 
Rectum,  reflexes  of,  638. 
Re-education    of    co-ordinated    move- 
ments in  tabes,  165. 
Referred  pain  in  visceral  disease,  seg- 
mental distribution  of,   62. 
Reflex  arc,  components  of,  26. 
Reflex  arc  of  the  knee-jerk,  28. 
Reflex,  Babinski,  15. 
Reflexes: 

diaphragm,  550. 

dispersion  of,  391. 

general  features  of,  390. 

inhibition  of,  391. 

origin  of,  392. 

regulative,  390. 

spinal  muscular,  n. 

symptoms,  503. 

tables  of,  642  et  seq. 

therapeutics  of,  392,  636. 

varieties  of,  28,  387,  417,  423,  436, 
440.  _ 

vaso-dilator  of  lung,  398,  526,  612. 

vertebral,  8. 

visceral,  7. 


670 


n 


d 


Reflexes  of  the  cranial  nerves,  440. 
Reflexotherapy,  581,  636. 
Respiration,  physiology  of,  288. 
reversed  forms  of,  288. 
sexual  types  of,  288. 
Respiratory  ataxia,  a  frequent  neurosis, 

85. 

Respiratory  mechanism,  289. 
Rheumatism,      diagnostic     pharmaco— 

therapy  of,  142. 
in  children,  143. 
differentiated  from  arthritis  defor- 

mans,  141. 

from  osteo-myelitis,  141. 
treatment  of,  142. 

Rheumatoid    arthritis    and    spinal    de- 
formity, 133. 
Rhizotomy,  393. 

Ribs,  deformity  of  as  a  factor  in  back- 
ache, 91. 

Rickets,  symptoms  of,  143. 
Rickets  and  spinal  deformity,  132. 
Ridlon's  exercises  in  lateral  curvature, 

161. 

Riedel's  lobe,  599. 
Rose's  method,  531. 
Round  shoulders,  96. 
and  backache,  53. 
exercises  for,  160. 


Sacro-iliac  disease,  in. 

relaxation,  111. 

diagnosis  of,  112,  113. 
Saddle-back,  116. 
Sapo  viridis,  613. 
Schneider's    explanation    of    Babinski 

reflex,  15,  16. 
Schott  method  in  heart  disease,  218. 

heart-reflex  the  essential  factor  in, 

218. 

Sciatica,  in  diagnosis  of  spinal  pain,  130. 
Scoliosis,  diagnosis  of,  45,  115. 

treatment  of,  115. 

varieties  of,  114. 
Scotoma,  540. 
Scrofula: 

glands  in,  613. 

nature  of,  139. 

Scurvy  and  spinal  deformity,  132. 
Senility  and  spinal  deformity,  132. 
Sensitive  areas: 

diagnosis  of,  69,  70. 

Loewi's  sign  in,  70. 

Mannkopffs  sign  in,  70. 


Segmental  distribution  of  referred  pain 

in  visceral  disease,  62. 
Segmental  skin-fields,  35. 
Seminal    vesicles    over-distended    as    a 

factor  in  backache,  87. 
Simulated  anesthesia,  in  litigation  backs 

98. 

Sinusoidal  current,  8,  n,  151. 
Kellogg's  apparatus,  154. 
uses  of,  155. 
Victor  apparatus,  155. 
Sinusoidalization : 

of  the  brain,  383-386. 
physiology  of,  381. 
Sismotherapy,  175. 
Soap,  green,  613. 
Spasm  of  muscles,  417. 
Spasm  of  spinal  muscles,  47,  421. 
Specific  cutaneous  nerves,  545. 
Sphygmomanometer  of  Riva-Rocci,  245. 
Sphygmomanometers,  244. 
Sphygmomanometry,  244. 
Spinal  column,  lateral  curvature  of,  41. 
length  of  individual  parts  of,  40. 
movements  of,  41,  42. 
Spinal  cord,  anatomy  of,  17. 
compression  of,  133. 
congestion  of,  126. 
physiology  of,  26. 
trophic  functions  of,  400. 
Spinal  curvatures,  varieties  of,  113. 
Spinal  curves,  39. 
Spinal    deformities,    differentiation    of, 

126,  128,  131,  132,  133. 
Spinal  disease,  muscular  rigidity  in,  52. 
Spinal  diseases,  diagnosis  of,  126. 
Spinal  examination  for  deformity,  44, 

45- 

Spinal  furrow,  19. 
Spinal  meningitis,  differential  diagnosis 

of,  144. 
Spinal  meningitis  in  diagnosis  of  spinal 

pain,  131. 
Spinal  muscles,  rigidity  of,  46. 

spasm  of,  41. 

Spinal  muscular  reflexes,  n. 
Spinal  nerves,  17. 

distribution  of,  18. 

localization  of,  24. 

Spinal  pains,  differentiation  of,  126,  128. 
Spinal  segment  defined,  30. 
Spinal  segments,  differentiated,  31. 

irritable,  439. 

relation  of  to  vertebral  spines,  37. 
Spinal  sprains,  119. 

nervous  symptoms  of,  119. 
Spinal  veins,  126,  127. 


671 


Spondylotherapy 


Spine,  diseases  of,  44. 

hysterical,  104. 

laborer's,  107. 

neurotic,  103,  406. 

percussion  zones  of,  559. 

tender  areas  of,  3. 

the  normal,  38. 

traumatism  of,  118. 

tumors  of  the,  121. 

typhoid,  121. 

Spinous  processes,  definition  of,  21. 
Splanchnic  area,  429. 
Splanchnic  nerves,  430. 
Splanchnic  neurasthenia,  252,  337,  432. 

factors  of,  346. 

treatment  of,  345,  434. 
Splanchnoscopy,  597. 
Spleen,  Banti's  disease  of,  357. 

reflex  of,  in  diagnosis  and  treat- 
ment of  malaria,  354-355. 

reflexes  of,  352,  353. 
Splenic  reflex,  in  treatment,  352,  355. 
Spondylitis  deformans,  106. 
Spondylitis,  varieties  of,  117. 
Spondylography,  42. 
Spondylolisthesis,  118. 
Spondylopathology,  388. 
Spondylotherapeutic    methods,     physi- 
ology of,  379,  387. 
Spondylotherapy,  in  etiology  of  disease, 

640. 

Static  current  in  differentiation  of  joint- 
lesions,  139. 
Stiff  back,  50. 

causes  of,  52. 

Stomach,  acute  dilatation  after  opera- 
tions, 320. 

percussion  of,  321,  584. 

dislocation  of,  323. 

motor  insufficiency  of,  324. 

treatment  of  motor  insufficiency  of, 

324. 

tympanites  a  factor  in  backache,  84. 
ulcer,  spinal  phenomena  in,  76. 
control  of  pain  bv  freezing,  76. 
diagnostic  data  of,  588. 
diseases  of,  588. 
further  advances  in  treatment  of, 

584- 

pharmacodiagnosis  of,  590. 

treatment  of  diseases  of,  591. 

X-ray  pictures  of,  584,  586. 
Stomach  reflex  of  contraction,  3 16,  332. 

in  diagnosis,  332. 
Stomach  reflex  of  dilatation,  318. 
Straining  at  stool  and  heart  reflex,  208. 
Strophanthin,  520. 


Subclavian  murmurs,  533. 
Sugar  production,  480. 
Suspension,  in  treatment,  478. 
Sympathetic  system,  427,  450. 
Sympathetic  system,  action  of  drugs  on, 

453,  5°9,  522. 

Sympathicotropic  action,  451. 
Swedish  gymnasts,  4. 
Sympathetic  sensations,  57. 
Sympathetic  system,  24. 
Syphilis  and  spinal  deformity,  133. 

Gibbert's  syrup  in,  140. 

in  heart  failure,  524. 

of  bones,  139. 

signs  of  congenital,  140. 

Wassermann  reaction  in,  140. 


Tabes,  405,  616. 
Table: 

of  pharmacology  of  reflexes,646. 

of  spondylodiagnosis,  642 

of  Spondylotherapy,  644. 
1 'aches  cerebrates,  277. 
Temperature,    bodily,    raised    by    con- 
cussion, 180. 

raised  by  pressure,  437. 

regulation  of,  437. 
Tenderness    in    visceral    disease,    seg- 

mental  distribution  of,  62. 
Tendon  reflexes,  probably  true  reflexes, 

29. 
Therapeutics,  physiologic,  389. 

results  of,  474. 
Thermo-therapy,  spinal,  174,  175,  403, 

405- 

Thiosinamin,  in  osteoarthritis,  108. 
Thymus  gland,  623. 
Thyroid,  483. 

diseases  of,  482. 

heart,  485. 

in  phthisis,  459. 
Tinnitus  aurium,  499. 
Tissue  vulnerability,  604. 
Tobacco,  effects  of,  540,  541. 
Tonsilitis,  523. 
Tonus,  muscular,  409. 
Topoalgias,  in  neurasthenia,  70. 
Tracheal  tug,  555. 
Trophic  diseases,  401. 
Tuberculin,  in  diagnosis  of  tubercular 

joint  lesions,  138. 
Tuberculosis,  joint  disease  in,  137. 

pulmonary,  602. 

treatment  of,  609,  612. 

sinusoidalization  in,  315. 
Tumors  of  the  spine,  121. 


672 


n 


d 


Tuning-fork,   in   testing   pain-suscepti- 
bility, 66. 

Transferred  pains,  5,  56. 

Traumatism  of  the  spine,  118. 

Typhoid    fever,    spinal    concussion    in 

diagnosis  of,  356. 
in  defervescence  of,  357. 

Typhoid  spine,  121. 

Ulcer,  gastric,  454. 
Uremia,  632. 

Uric  acid  diathesis  localized  in  muscles, 
158. 

sinusoidalization  in,  158. 
Uric  acid,  diet  in,  102. 

foods,  102. 

Uric  acid  theory  of  disease,  101. 
Uterus  reflex,  the,  358. 
Uterus,  anomalies  in  position,  420. 

Vagal  phenomena,  470. 
Vagus: 

anatomy  of,  446. 

diagnosis  of  tone,  453. 

hypertonia  of,  452. 

hypotonia  of,  452. 

physiology  of,  448. 

pathology  of,  448. 

tone  and  sense  organs,  462. 

tonus  of,  451. 
Vagus-tone: 

diseases  caused  by,  479. 

methods  of  decreasing,  472. 

methods  of  increasing,  469. 
Vasoconstrictor  nerves,  274,  278. 
Vasodilator  nerves,  274,  278. 
Vaso-dilator  lung  reflex,  398. 
Vaso-motor  apparatus,  the,  272. 
Vaso-motor  ataxia,  424. 
Vaso-motor  instability,     treatment     of, 

279. 
Vaso-motor  nerves,  pathology  of,  275. 

course  of,  425. 
Vaso-motor  neuroses,  275. 

treatment  of,  278. 
Vaso-motor  reactions,  425. 
Vaso-motor  reflex,  273. 
Vaso-motor  sufficiency,  test  of,  240. 
Vaso-motor  temperament,  424. 
Veins,  spinal,  126,  127. 
Vertebral   areas,   involved  in  muscular 
spasm,  49. 

artery,  compression  of,  21. 

column,  uses  of,  38. 

insufficiency,  122. 

pains,  66. 

percussion,  19,   559. 


Vertebral,  continued 

spines,   relation  of   to   spinal  seg- 
ments, 37. 

reflexes,  mechanism  of,  10. 

excitation  of,  8. 
Vertebral  tenderness: 

Alsberg's  comments  on,  71. 

and  congestion  of  cord,  126. 

and  localized  muscular  spasm,  78. 

elicited  by  palpation  of  organs,  75. 

elicited  by  irritation  of  skin,  78. 

elicited  in  gout,  76. 

elicited  in  stomach  ulcer,  76. 

in  neurasthenia,  70. 

inhibited  by  freezing,  75. 

physiology  of,  72. 
Visceral  disease,  table,  74. 
Vibra-massage,  176,  181. 
Vibration,  inefficiency  of,  394. 
Vibro-suppression,     in     percussion     of 

chest,  80. 
Vibro-suppressor,  illustration  of,  81. 

use  of,  82. 
Visceral  diseases,  differential  diagnosis 

of,  189. 

Visceral  reflexes,  7. 
Visceral    reflexes,     elicited    by    spinal 

pressure,  170. 
Viscero-motor  centers,  36. 

table  of,  36. 

Visceral  musculature,  399. 
Visceral  pain,  415,  417,  439. 
Visceral  phenomena,  411. 
Visceral  tone,  462,  465,  510. 


Wassermann  reaction,  in  syphilis,  140, 

522. 

Noguchi's  modification  of,  140. 
Whooping  cough,  619. 
Wintergreen,  oil  of,  in  lumbago,  100 
Wohlgemuth,  method  of,  600. 
Wolf's  law,  546. 
Women,  backache  in,  84. 
coccygodynia  in,  95. 
dysmenorrhoea  in,  treated  by  spinal 

pressure,  358. 
pelvic    backaches    of,     Garrigues' 

classification,  89. 

pelvic  disease  as  a  factor  in  back- 
ache, 88. 
pelvic  pain  in,  Kelly's  observation, 

89. 

reversed  type  of  breathing  in,  86. 
sacro-iliac  backaches  of,  112. 
uterus  reflex  in,  358. 
X-ray  diagnosis  of  aneurysm,  561. 


673 


PROGRESSIVE 
SPONDYLOTHERAPY 

1913 

A  SUMMARY  OF  NEW 
CLINICO-PHYSIOLOGIC  AND 
REFLEXOLOGIC  DATA 

WITH  AN  APPENDIX 

ON  THE  PHYSIOLOGICAL  PHYSICS  OF  THE 
VARIOUS    FORMS    OF    FORCE 

BY 

ALBERT  ABRAMS,  A.  M.,  M.  D. 

(UNIVERSITY  OF  HEIDELBERG) 

F.  R.  M.  S. 

HONORARY    PRESIDENT    OF    THE    AMERICAN    ASSOCIATION    FOR 
THE     STUDY     OF.  SPONDYLOTHERAPY;     CONSULTING     PHYSI- 
CIAN TO  THE  MOUNT  ZION  AND  FRENCH  HOSPITALS,   SAN 
FRANCISCO;    FORMERLY    PROFESSOR    OF    PATHOLOGY 
AND  DIRECTOR  OF  THE  MEDICAL  CLINIC,   COOPER 
MEDICAL    COLLEGE     (DEPARTMENT    OF    MEDI- 
CINE  LELAND   STANFORD   JUNIOR  UNIVER- 
SITY),  SAN  FRANCISCO;  MEMBER  OF  THE 
AMERICAN    MEDICAL    ASSOCIATION.      • 

REPRESENTING      THE      ADDITIONAL      SUBJECT- 
MATTER   INCLUDED   IN   THE   FIFTH   EDITION 
OF  SPONDYLOTHERAPY 

(PHYSIO-THERAPY  OF  THE  SPINE  BASED  ON  A  STUDY  OF 
CLINICAL  PHYSIOLOGY) 

PHILOPOLIS  PRESS,  SUITE  406,  LINCOLN  BUILDING 

SAN  FRANCISCO 

1913 


COPYRIGHT.   1913 

BY 
ALBERT  ABRAMS 


TO 

SIR  JAMES  BARR,  M.  D.,  LL.  D.,  F.  R.  S.  E., 

CONSULTING    PHYSICIAN,    THE    ROYAL    INFIRMARY,    LIVERPOOL, 
AND  PRESIDENT  OF  THE  BRITISH  MEDICAL  ASSOCIATION. 

THIS  VOLUME  IS  INSCRIBED 

IN   RECOGNITION    OF    HIS    FRIENDSHIP    AND    OF    HIS    DISTIN- 
GUISHED SERVICES  IN  THE  ADVANCEMENT  OF  MEDICINE 


PREFACE. 

THE  first  edition  of  Spondylotherapy  was  published  in  1910 
and  since  that  time  four  editions  of  the  work  have  been 
issued.  To  avoid  the  necessity  of  a  new  edition,  which 
has  become  imperative,  this  volume  is  designed  to  substitute 
the  latter.  The  subject-matter  of  the  appendix  is  an  attempt  to 
further  rationalize  physiotherapy  and  to  remove  the  stigma  still 
associated  in  the  minds  of  many  with  this  almost  empirical  meth- 
od of  therapeutics.  When  Spondylotherapy  was  first  published 
many  statements  seemed  incredible  and  only  the  cognoscenti 
could  interpret  its  true  significance.  Spondylotherapy  or  reflex- 
otherapy,  was  equally  an  attempt  to  rationalize  crude  methods 
practised  by  the  Japanese  under  the  name  Knatsu,  and  by  the 
Chinese  as  Tcha-Tchin. 

Commenting  on  the  latter  the  Abbe  Grosier,  at  the  end  of  the 
18th  century  observed,,  "L'efficacite  de  ce  trait  ement,  est  pronvee 
par  dcs  guerisons  sans  nombre  et  qui  semblent  surnaturelles." 

The  data  in  the  appendix  appear  equally  incredible  but  truth 
is  established  neither  by  convictions  nor  theorization.  The 
maneuvers  suggested  by  the  author  are  simple  and  easily  exe- 
cuted and  judgment  should  be  reserved  until  they  have  been 
tried.  The  term  force  in  the  appendix  is  employed  in  its  popular 
sense.  Atomic  energy  like  matter,  in  accordance  with  the  law  of 
the  Conservation  of  Energy,  is  indestructible  and  uncreatable 
and  must  be  regarded  as  a  separate  entity.  Energy  before  as- 
sociation with  the  position  of  one  body  in  reference  to  another 
is  potential  in  contrast  with  kinetic  energy  or  the  energy  of 
motion. 

The  fact  that  I  have  solicited  physiology  to  contribute  its  share 
in  clarifying  some  problems  should  occasion  no  surprise. 

The  laws  of  physical  science  are  universal  and  apply  equally 
to  living  organisms  and  so-called  inanimate  things. 

This  iatrophysical  conception  demonstrates  the  trend  of  Uni- 
fying the  various  forms  of  force  under  one  great  principle. 

A.  A. 

246  POWELL  ST., 
SAN  FRANCISCO,  CAL., 
APRIL,  1913. 


CONTENTS 

CHAPTER  I. 

Page 
General   Reflexo-Diagnosis       -  ...  1 

CHAPTER  II. 
General  Reflexo-Therapy  36 

CHAPTER  III. 
The  Circulatory  Apparatus  -  50 

CHAPTER  IV. 

The    Digestive    Apparatus  80 

CHAPTER  V. 
Miscellaneous  Reflexes  and  Data  -  -  100 

CHAPTER  VI. 
Electronotherapy  -  115 

CHAPTER  VII. 
Magnetic  Force  -  131 

CHAPTER  VIII. 
Physics  of  the  Magnetic  Force  -  138 

CHAPTER  IX. 
Physiological  Physics  of  the  Magnetic  Force  -  142 

CHAPTER  X. 
Deductions  -  -  -  173 

GLOSSARY  --..„_  209 
BIBLIOGRAPHY  -  --_.._.  212 
INDEX  -  -  -  - *  213 


PROGRESSIVE   SPONDYLOTHERAPY* 
CHAPTER  I. 

GENERAL  REFLEXODIAGNOSIS. 

SCOPE  OF  SPONDYLOTHERAPY— REFLEXO-DIAGNOSIS— FUNCTION- 
AL DIAGNOSIS— VISCERAL  TONOMETRY— SPONDYLOPRESSOR— 
VAGO-VISCERAL  METHODS — DIAGNOSIS  OF  INTUITIONAL 
ACTS — BACKACHE  AND  VERTEBRAL  TENDERNESS— REFERRED 
PAIN— DIAGNOSIS  OF  HYSTERIA. 

SCOPE    OF  SPONDYLOTHERAPY. 

My  friend,  Dr.  H.  Jaworski,  of  Paris,  France,  first 
suggested  the  name,  "REFLEXOTHERAPY"  (636).  He 
further  suggests  "REFLEXO-SPONDYLOTHERAPY." 

Dr.  J.  Madison  Taylor,  and  Dr.  Louis  von  Cotz- 
hausen,  protest  against  the  employment  of  the  word 
spondylotherapy  contending  that  the  designation  is 
too  limited  in  scope  to  do  justice  to  the  subject  which 
embraces  not  only  new  methods  of  treatment  but  new 
methods  of  diagnosis.  Dr.  von  Cotzhausen  proposes 
the  neologism,  "REFLEXOLOGY." 

Spondylotherapy,  may  suggest  exclusivism  to  the 
captious  critic  and  so  would  electrotherapy  and  hyd- 
rotherapy  but  time  has  removed  this  stigma  from  the 
devotees  of  the  latter  methods  of  practice. 

In  the  preface  to  the  third  edition  of  SPONDYLO- 
THERAPY and  elsewhere  in  the  same  work  (387),  its 
purport  has  been  fully  expounded.  The  latter  is  no 
more  suggestive  of  an  exclusive  method  of  practice 
than  is  electrotherapy  but  only  emphasizes  the  impor- 
tance of  the  spinal  cord  as  the  center  for  the  dis- 
charge of  the  majority  of  reflex  actions. 

*Numbers  in  parentheses  refer  to  the  pages  in  the  last  edition  of  SPON- 
DYLOTHERAPY where  the  subject  has  already  been  discussed.  When  the 
word  "page"  precedes  the  number  it  refers  to  the  present  edition  of  pro- 
gressive spondylotherapy. 


Progressive     Spondylotherapy 

Throughout  many  works  on  different  subjects,  the 
author  has  constantly  referred  to  his  vertebral  re- 
flexes but  they  were  practically  ignored  until  they 
were  collated  in  his  book,  "SPONDYLOTHERAPY." 

There  still  lingers  the  doctrinaire  who  confuses 
spondylotherapy  with  osteopathy.  With  like  astig- 
matic mentality,  the  orthopedist  could  be  accounted 
an  osteopath  for  the  reason  that  he  treats  diseases 
of  the  backbone. 

Anent  osteopathy,  a  kindly  word  should  be  said  of 
some  of  the  proselytes  of  this  cult  who  are  now  recog- 
nizing certain  errors  in  their  early  conception  of 
disease. 

One  of  the  fundamental  principles  of  osteopathy 
was  that  diseases  were  caused  by  dislocations  of  the 
vertebrae  which  by  exerting  pressure  on  the  spinal 
nerves  induced  derangements  of  functions.  By  push- 
ing and  pulling  the  vertebrae  into  place,  the  " lesions" 
could  be  corrected. 

Dr.  J.  Madison  Taylor,  has  studied  this -subject 
from  an  unprejudiced  viewpoint  and  quotes  the  high- 
est authorities  on  anatomy  to  show  that,  except  when 
long-standing  or  progressive  morbid  processes  have 
been  the  cause  (lateral  curvature  and  tubercular  dis- 
ease), changes  in  the  relationship  of  the  vertebrae 
are  practical  impossibilities. 

This  authority1  observes :  "Relaxations  of  the  lat- 
eral and  posterior  spinal  ligaments  are  due  to  nutri- 
tive faults.  There  is  produced  often  the  appearance 
of"  dislocation,  but  these  morphologic  phenomena 
disappear  on  restoration  of  the  tonus  of  the  shrunk- 
en tissues,  chiefly  through  mechanical  stimulation. 
Attempts  to  'replace'  these  so-called  'dislocated 
bones'  and  to  relieve  pressure  on  nerves, — the  creed 
of  the  osteopath, — sometimes  result  in  benefit,  not 
by  accomplishing  the  object  aimed  at,  but  through 
the  effects  wrought  upon  the  centers  of  vasotonus 
and  lymph  activities  by  mechanical  or  other  stimu- 


Scope     of     Spondylo therapy 


lation.  Where,  as  sometimes  happens,  undue  force 
is  used  to  'pull  or  push'  these  tissues  in  place,  harm 
is  often  wrought  of  which  little  is  said,  or  to  which 
other  causes  are  assigned.  Thus  any  agent  which 
causes  vasoconstriction  in  the  tissues  of  the  back 
contiguous  to  the  spinal  column  will  produce,  con- 
versely, dilation  of  the  vessels  in  the  cord  and  of 
the  organs  and  parts  beyond  the  line  of  innervation. 

"Any  agent  which  produces  dilatation  of  the  ves- 
sels supplying  the  tissues  of  the  back  will,  by  com- 
pensatory action,  induce  constriction  in  the  blood- 
vessels of  the  cord  and  parts  beyond.  The  signifi- 
cance of  this  is  at  once  made  plain,  and  its  value, 
not  only  as  a  factor  in  diagnosis,  but  in  treatment, 
manifest. 

"On  inspecting  the  back  of  one  who  is,  and  has 
always  been,  perfectly  sound,  there  will  be  seen  (if 
certain  attitudes  are  assumed  to  bring  them  into 
prominence)  the  spines  of  the  vertebrae  in  normal 
alignment,  distance  apart,  and  degree  of  posterior 
projection.  If  there  has  been  a  history  of  long-con- 
tinued or  recurrent  disturbances  of  the  internal  or- 
gans, these  are  frequently  revealed  by  alterations  in 
the  tonus  of  the  blood-vessels  of  those  muscles  and 
other  tissues  innervated  by,  or  lying  adjacent  to, 
the  governing  segments  of  the  cord  from  which  the 
organs  at  fault  are  reflexly  controlled  through  their 
vasomotor  connections.  The  change  of  form  exhib- 
ited is  an  atrophy  of  some,  infiltration  and  thicken- 
ing of  others,  and  if  long  continued,  asymmetries 
of  the  vertebrae,  the  spines  apparently  pointing  in 
different  directions.  If  the  lesions  have  become 
chronic,  the  spines  are  found  separated  owing  to 
the  relaxation  of  the  posterior  ligaments,  until  be- 
tween two  or  more  marked  depressions  appear,  or 
several  are  depressed  below  the  normal  line  of 
projection.  This  disarrangement  of  the  vertebrae 
is  more  apparent  than  real,  the  asymmetries  being 
due  to  loss  of  tone  and  relaxation  in  the  supporting 
ligaments,  and  this  disappears  under  appropriate 
treatment." 

Dr.  Earle  Scanland  Willard,  one  of  the  most  emi- 
nent authorities  on  the  subject  of  osteopathy  urges 
academic  revision  of  the  principles  of  osteopathy 
based  on  most  careful  research  work.  He  observes : 

3 


Progressive     Spondyloth  er  apy 

-2"It  -seems  that  the  explanation  of  the  lesion  rests 
upon  something  more  than  mere  pressure  of  mal- 
adjusted tissue  upon  nerve-fiber  or  vascular  channel ; 
this  at  best  can  be  only  part  of  the  physiological  dis- 
turbance of  the  muscular,  fascial,  ligamentous,  and 
osseous  tissues  which  causes  interference  with  the 
normal  afferent  influence  to  the  spinal  cord  centers, 
and  this  is  more  or  less  permanently  maintained  by 
the  lack  of  freedom  of  the  joint  movements. 

Neither  macroscopic  nor  microscopic  findings  in 
the  tissues  passing  through  the  spinal  foramen  war- 
rant the  assumption  that  the  osteopathic  lesion  is  the 
result  of  mechanical  pressure  in  this  region." 

Hippocrates  must  have  anticipated  sectarian  prac- 
tice with  relation  to  the  spine.  I  find  in  his  chapter 
on  "Articulations"  that,  after  enjoining  the  physi- 
cian to  know  the  spine  as  requisite  in  many  diseases, 
he  inveighs  against  the  practice  of  attributing  cure 
to  the  reduction  of  dislocated  vertebrae  thus  profiting 
by  the  ignorance  of  others.  Curvature  of  the  spine, 
he  continues,  occurs  even  in  health  from  natural  con- 
formation, from  habit,  old  age  and  from  pains. 

The  osteopaths  have  recently  protested  against 
what  they  regard  as  an  encroachment  on  their  domain 
and  claim  that  I  have  purloined  their  ideas.  This 
abuse  is  couched  in  less  elegant  though  in  more  cogent 
phraseology.  I  have  shown  that  the  primal  concep- 
tion of  this  cult  has  been  discredited  by  its  leaders. 
If  the  vertebral  column  and  spinal  cord  have  been 
patented  then  my  researches  must  be  regarded  as  an 
infringement  and  a  caveat  emptor  should  be  issued. 
I  fear  however,  that  my  detractors  are  in  the  same 
position  as  the  dramatist  whose  manuscript  was 
rejected.  Later,  he  witnessed  a  play  in  which  ' ' stage- 


Reflexo    -    Diagnosis 

thunder"  was  also  employed  and  excitedly  cried, 
"They've  stolen  my  thunder." 

REFLEXO-DIAGNOSIS. 

Many  reflex  acts  are  so  perfectly  coordinated  that 
one  is  constrained  to  believe  that,  in  the  spinal  cord 
there  exists  a  subsidiary  brain. 

Man  is  practically  an  automaton  and  many  of  the 
phenomena  of  vegetative  life,  respiration,  circula- 
tion, nutrition,  etc.,  are  produced  in  the  subconscious 
state  and  without  voluntary  effort.  Eating,  drinking, 
walking,  in  short,  the  essential  acts  of  life,  are  but  a 
mass  of  habits,  and  eventually  conform  to  the  laws  of 
habit.  Their  repetition  eventuates  in  reflex  actions. 
It  is  wise  that  this  is  so,  otherwise  the  mind  would  be 
so  occupied  that  acts  requiring  volitional  deliberation 
could  not  be  executed.  Instinct  is  an  adaptive  impulse 
in  the  absence  of  intelligence,  yet  instinct  is  made  up 
of  reflex  acts  purely  automatic  and  without  the 
domain  of  the  mind. 

The  bee  constructs  a  perfect  cell  without  a  mathe- 
matical education,  and  birds  migrate  without  chart 
or  compass. 

All  diseases  are  manifested  by  a  direct  and  indirect 
symptomatology ;  the  latter  embrace  the  reflex  symp- 
toms. There  are  individuals  who  are  reflexophilic, 
i.  e.,  they  have  exaggerated  reflexes. 

If  the  life  of  an  animal  is  essentially  a  series  of 
reflex  actions  and  pathology  is  nought  else  but  the 
physiology  of  the  sick,  then  the  reflexes  must  assume 
primary  importance  in  diagnosis.  In  visceral  dis- 
eases, symptoms  are  often  referred  to  the  somatic 
area  (411). 

In  other  instances,  the  reflexes  are  essentially  com- 
pensatory or  for  purposes  of  defense  (191). 


Progressive     Spondylotherapy 

FUNCTIONAL  DIAGNOSIS. 

Montaigne  has  observed,  "Even  as  Nature  makes 
us  to  see  that  many  dead  things  have  yet  certain 
secret  relations  to  life."  The  time  was,  when  the 
chief  goal  of  the  pathologist  was  to  discover  some 
morbid  change  for  every  disease  but  the  study  of  the 
living  has  supplanted  the  study  of  the  dead  and  the 
consequence  is,  the  passing  of  morbid  anatomy. 

We  no  longer  strive  to  make  the  clinical  correspond 
with  the  anatomical  findings  and  picture  in  our  minds 
the  pathologic  conditions  prevailing  in  disease. 

Our  chief  aim  is  to  make  a  functional  diagnosis 
which  takes  cognizance  of  anomalies  in  the  physiolog- 
ic functions  of  the  viscera.  Physiologic  fluctuations 
may  be  resident  in  an  organ  even  before  a  path- 
ologico-anatomic  substratum  is  assumed  to  exist. 
The  recent  advances  made  in  pathology  and  thera- 
peutics have  been  mainly  along  the  lines  of  func- 
tional diagnosis. 

VISCERAL  TONOMETRY. 

I  believe  that,  in  my  work  on  "Diagnostic-Thera- 
peutics," the  first  systematic  attempt  was  made  to 
study  the  viscera  with  reference  to  their  functional 
sufficiency  (215).  Since  then,  by  aid  of  a  simple 
apparatus  which  will  be  described  later,  coupled  with 
a  recognition  of  the  visceral  reflexes,  it  is  now  possible 
to  gauge  the  capacity  of  an  organ  to  execute  its  func- 
tions, i.  e.,  to  measure  its  visceral  tone.  The  utter 
helplessness  of  the  physician  to  achieve  such  results 
by  conventional  methods  only  emphasizes  the  fact 
that  conjecture  often  plays  a  predominant  role  in 
medical  practice.  Take  so  plebian  an  affection  as 
constipation  and  I  venture  to  say  that,  heretofore  it 
was  impossible  to  recognize  it  objectively. 

The  capacity  of  an  organ  to  execute  its  functions 


Visceral     Ton    ometry 

is  determined  by  the  tone  of  its  musculature   (409 
and  451). 

THE  VISCERAL  MUSCLE. — This  is  usually  in  the  form 
of  a  membrane  or  sheet  but  in  certain  situations 
(uterus,  pylorus),  it  is  thick  and  well  developed. 
Unlike  the  skeletal,  the  visceral  muscle  receives  its 
stimuli  not  directly  but  indirectly  through  the  inter- 
mediation of  ganglion  cells.  The  visceral  muscula- 
ture shows  elasticity,  tonicity,  irritability  and  con- 
ductivity. There  is  a  distinct  periodicity  in  the  move- 
ments of  visceral  muscle  characterized  by  contrac- 
tion and  relaxation  of  the  muscle-fibers. 

If  the  latter  are  stimulated  by  the  induced  or  con- 
stant current,  the  contraction  takes  place  more  rap- 
idly than  the  relaxation,  the  two  phases  occupying 
5  and  35  seconds  respectively  with  a  latent  period  of 
0.25  second.  In  our  treatment  notably  by  aid  of  elec- 
tricity the  foregoing  facts  are  important.  The  vis- 
ceral musculature  is  plain  or  involuntary  and  does 
not  respond  to  stimulation  like  voluntary  muscle. 
Strong  currents  (notably  the  sinusoidal  current)  are 
necessary  and  the  rate  of  stimulation  to  produce  a 
tetanic  contraction  is  slower  than  for  cross-striped 
muscle.  The  best  effects  are  achieved  by  a  stimulus 
acting  every  five  seconds.  The  slow,  long-waved  sinu- 
soidal current  is  best  to  secure  such  effects. 

THE  VISCERAL  REFLEXES  (7,  et  seq.). — These  organ- 
ic reflexes  are  chiefly  concerned  with  involuntary 
non-striated  muscles  which  are  dominated  by  the 
sympathetic  nervous  system  and  are  incapable  of  di- 
rect voluntary  restraint.  In  the  norm,  the  visceral 
reflexes  do  not  implicate  consciousness.  In  visceral 
pain  (415)  or,  when  the  reflex  act  stimulates  a  cere- 
bro-spinal  sensory  nerve,  consciousness  may  be  reach- 
ed. The  latter  is  also  evoked  when  voluntary  muscles 

7 


Progressive     Spondylotherapy 

must  supplement  an  organic  reflex.  Defecation  is  in- 
voluntary respecting  intestinal  movements  but  in 
stimulation  of  the  rectal  mucosa,  the  perineal  muscles 
are  brought  into  action  and  the  reflex  becomes  con- 
scious and  voluntary. 

The  scrotal  reflex  is  a  typical  sympathetic  motor 
phenomenon  and,  like  the  other  organic  motor  re- 
flexes, the  contraction  is  slow  and  worm-like  and  not 
brisk  like  the  reflexes  of  striated  muscle. 

In  addition  to  the  sympathetic  system  described 
elsewhere  (427,  450),  there  are  also  microscopic  gan- 
glia (micro-sympathetic  ganglia),  demonstrable  by 
the  microscope  and  located  below  the  union  of  the 
anterior  and  posterior  nerve  roots  of  the  spinal 
nerves.  The  function  of  the  latter  is  unknown. 

MAINTENANCE  OF  VISCERAL  TONE. — Visceral  tone  is 
practically  a  reflex  due  to  a  constant  flow  of  impulses 
from  an  organ  along  sensory  paths  and  the  transla- 
tion of  such  impulses  into  tonic  discharges  from  the 
motor  neurons  in  the  cord.  The  foregoing  represents 
the  neurogenic  tonus.  It  has  been  shown  elsewhere 
(451),  that,  the  tonus  of  the  sympathetic  fibers  is 
maintained  by  the  secretion  of  adrenalin  but  that 
similar  internal  secretion  is  yet  to  be  demonstrated 
for  maintaining  the  tonus  of  the  autonomic  fibers 
which  is  represented  by  the  extended  vagus  (450). 

Meltzer  and  Cannon,  have  shown  that  stimula- 
tion of  the  peripheral  end  of  the  splanchnic  augments 
the  secretion  of  adrenalin  which  is  indicated  by  dila- 
tation of  the  pupil.  The  latter  is  hardly  a  sufficient 
criterion  for  adrenalin  action. 

In  studying  the  action  of  adrenalin  on  the  viscera 
by  hypodermatic  injections  of  adrenalin  in  the  hu- 
man, the  following  were  noted : 

1.     Dilatation  of  the  pupil  (452,  522). 

8 


Spondylopr     essor 

2.  Evanescent  increase  of  blood-pressure. 

3.  Constriction  of  the  majority  of  blood-vessels. 
Dilatation  of  aneurysms  (457)  and  the  pul- 
monary blood-vessels  (607). 

4.  Contraction  of  the  lungs  (314,  456). 

5.  Dilatation  of  the  stomach  (590). 

This  action  of  adrenalin  may  be.  duplicated  in  the 
human  by  stimulation  of  the  splanchnic  nerves  (430, 
434).  The  best  effects  are  achieved  by  limiting  the 
stimulation  from  the  4th,  to  the  8th  dorsal  spines. 

A  like  effect  may  be  noted  by  stimulation  of  the 
phrenic  nerve  at  its  exit  (549).  Here,  I  have  assum- 
ed is  another  source  of  stimulating  the  secretion  of 
the  suprarenal  glands:  the  latter  being  supplied  by 
the  phrenico-abdominal  branches.  The  pancreas  has 
probably  an  inhibitory  influence  on  the  secretion  of 
adrenalin  (452).  In  accordance  with  this  theory 
aided  by  my  method  of  duodenal  intubation  (page 
85),  I  determined  that,  one  may  augment  the  pancre- 
atic secretion  by  application  of  a  stimulus  to  the  10th 
dorsal  spine  and  that,  during  and  f  or«some  time  after, 
the  tonicity  of  the  sympathetic  is  reduced. 

If  dilatation  of  the  splanchnic  vessels  is  accepted  as 
a  criterion  of  an  effect  opposed  to  splanchnic  stimu- 
lation, its  effect  can  be  achieved  by  the  method  cited 
on  page  55.  An  overproduction  of  epinephrin  is  res- 
sponsible  for  many  symptoms  notably,  hypertension 
and  glycosuria. 

SPONDYLOPRESSOR 

Pressure  at  definite  paravertebral  areas  will  ewke 
specific  visceral  reflexes  (169).  Practically  all  the  vis- 
cera innervated  by  the  vagus  (448)  may  be  brought 
to  contraction  by  application  of  the  stimulus  to  the 
7th  cervical  spine  (467). 

9 


Progressive     Spondylo  therapy 

The  vagus  includes  those  roots  formerly  specified 
as  the  "bulbar  part  of  the  spinal  accessory."  The 
latter  is  limited  to  the  spinal  part  of  the  accessorius 
and  is  a  continuation  of  the  vagus  nucleus  in  the 
medulla. 

It  has  been  suggested  (467),  to  make  pressure  for 
one  minute.  Mature  experience  has  shown  that  the 
pressure  should  not  exceed  one-half  minute,  other- 
wise the  reflex  is  exhausted. 

A  curious  physiologic  phenomenon  has  been  not- 
ed with  reference  to  the  exhaustion  of  neurogenic 
tonus  at  the  7th  cervical  spine  and  elsewhere.  One 
may  stimulate  the  vagus  reflexly  from  a  number  of 
situations  (229). 

As  a  paradigm,  select  the  stomach  reflex  of  con- 
traction (316).  Within  a  few  seconds  after  pres- 
sure is  made  with  the  radicular-pressor  (649),  at 
the  7th  cervical  spine,  the  tympanitic  area  of  the 
stomach  yields  a  dullness  but,  if  the  pressure  ex- 
ceeds one-half  minute,  the  dullness  is  again  sup- 
planted by  tympanicity  because  the  reflex  is  ex- 
hausted. When  pressure  at  the  7th  cervical  spine 
will  no  longer  elicit  the  reflex,  pressure  in  an  inter- 
costal space  will  again  evoke  the  reflex.  The  deduc- 
tion is  evident;  only  the  afferent  paths  (not  the 
vagus  itself)  were  exhausted.  This  phenomenon 
suggests  the  rationale  of  many  therapeutic  proced- 
ures and  demonstrates  how,  one  may  utilize  other 
afferent  paths  in  the  excitation  of  centers  which 
cannot  be  reached  by  paths  already  enervated. 

Visceral  tonometry  by  aid  of  the  spondylopressor 
(Fig.  1)  guages  neurogenic  tonus,  myogenic  tonus  or 
both.  With  reference  to  the  heart,  if  the  neurogenic 
tonus  is  normal,  pressure  at  the  7th  cervical  spine 
will  not  inhibit  the  pulse  even  though  the  pressure 
registers  10  kilograms. 

If,  however,  vagus  tone  is  diminished  as  in  exoph- 
thalmic goitre  (page  74,)  one  cannot  feel  the  pulse 
(during  the  time  of  pressure)  when  the  pressure  has 
attained  3  or  5  kilograms.  In  the  latter  affection 
however,  the  myocardium  is  efficient  as  a  rule,  there- 

10 


Spondylopr     essor 

fore  recourse  must  be  had  to  another  method  for  de- 
termining the  sufficiency  of  the  latter.  Estimate  the 
pressure  in  kilograms  necessary  to  increase  precor- 
dial  dullness  (471).  As  a  rule,  a  pressure  of  5  kilo- 
grams will  augment  the  latter  whereas  in  myocardial 
insufficiency,  the  full  pressure  of  10  kilograms  fails  to 
modify  the  percussion  note. 


FIG.  1. — Spondylopressor  with  reflexometric  attachment.  A,  attachment 
for  use  as  an  algesispondylometer;  B,  attachment  for  use  as  an  algesi- 
meter  elsewhere  in  the  body;  C,  attachment  for  gauging  the  vigor  of  the 
spinal  and  abdominal  muscles. 

Atonic  constipation  (328)  is  more  frequent  than 
the  spastic  variety.  If  pressure  is  made  at  the  2nd 
lumbar  spine  the  tympanitic  intestines  become  dull 
if  there  is  no  constipation  whereas  in  the  presence 
of  the  latter,  the  full  10  kilograms  of  pressure  will 
cause  no  change  in  the  percussion  sound.* 

A  minimum  pressure  of  4  kilograms  at  the  7th  cer- 
vical spine  is  necessary  to  cause  a  descent  of  the  nor- 
mal or  orthotonic  lung.  In  the  hypertonic  lung 
(asthma),  the  lower  lung-border  descends  with  a 
pressure  of  1  kilogram. 

Aside  from  the  employment  of  the  foregoing  ap- 
paratus as  a  reflexometer,  the  author  has  employed  it 
for  the  following  purposes  : 

*For  further  details  concerning  the  employment  of  the  spondylopressor 
in  the  diagnosis  of  visceral  reflexes,  vide  pages  34  and  74. 

11 


Progressive     Spondylotherapy 

1.  As  an  algesimeter,  to  measure  the  reaction  to 
pain  by  kilograms  of  pressure.    The  attachment  (A) 
is  employed  to  measure  vertebral  points  of  tender- 
ness whereas  the  disk  (B)  is  used  for  measuring 
pain  elsewhere.    One  may  also  utilize  this  apparatus 
for  determining  the  progress  of  a  malady  by  the  res- 
ponse to  pain  by  diminished  or  increased  kilograms 
of  pressure. 

2.  As  a  baresthesiometer.    Afferent    peripheral 
impulses  are  conducted  along  distinct  classes     of 
nerve—fibers  and  common  sensation  is  made  up  of 
three  kinds  of  sensibility : 

a.  Deep  sensibility  recognizes     deep     pressure 
which,  if  excessive  causes  " pressure-pain."      This 
sensibility    takes    cognizance  of    sensations    from 
muscles,  joints  and  the  vibration  sense  (66).    These 
sensory  impulses  are  not  annihilated  by  division  of 
the  sensory  cutaneous  nerves. 

b.  Protopathic  sensibility  recognizes  painful  cut- 
aneous stimuli  (pin-pricks)  and  extreme  degrees  of 
heat  and  cold. 

c.  Epicritic  sensibility  responds  to  light  touches 
(cotton- wool)  and  finer  grades  of  temperature. 

The  foregoing  differences  are  applicable  only  to 
the  peripheral  nerves  (extra-spinal  portion  of  the 
sensory  paths) . 

In  peripheral  neuritis,  the  deep  hyperalgesia  and 
cutaneous  anesthesia  (cotton-wool  touch  unperceiv- 
ed)  is  diagnostic  in  contrast  to  the  condition  prevail- 
ing in  locomotor  ataxia,  viz.,  association  of  superficial 
and  deep  analgesia. 

Peripheral  sensory  impulses  pass  to  the  spinal-root 
ganglia  then  through  the  posterior  roots  to  the  cord. 
In  the  latter,  there  is  no  separation  of  the  deep  and 
superficial  pain-fibers  hence  in  certain  diseases  of  the 

12 


V  a  g  o-V  isceral    Methods 

spinal  cord,  perception  of  pain  as  a  whole  is  annihil- 
ated and  the  pain  of  a  pin-prick  or  deep  pressure  is 
equally  abolished. 

3.  For  testing  rigidity  of  the  muscles  of  the  back 
or  elsewhere.  Here,  the  small  ring  (C)  rests  below 
attachment.  The  pressure  in  kilograms  necessary  for 
the  surface  of  the  ring  to  attain  the  surface  of  the 
skin  indicates  the  rigidity. 


FIG.  2. — Skiagrams  of  an  aneurysm  treated  by  Dr.  George  Jarvis  of 
Philadelphia.  Also  show  the  areas  of  heart  and  aneurysm,  as  determined 
by  percussion  with  corroboration  of  the  latter  by  the  X-ray  findings.  A, 
skiagram  before  conclusion  of  the  7th  cervical  spine;  B,  diminished  area 
after  concussion;  C,  from  same  patient  symptomatically  cured  after 
treatment  for  one  month. 

4.  For  testing  the  tone  of  the  abdominal  muscles 
in  splanchnic  neurasthenia  (427).  Fix  instrument 
on  abdominal  region  at  a  pressure  of  4  kilograms  and 
observe  how  many  more  kilograms  of  pressure  may 
be  recorded  when  the  patient  contracts  the  abdominal 
muscles. 

V  AGO-VISCERAL  METHODS. 

The  inaccuracy  of  delimiting  the  viscera  by  topo- 
graphic percussion  by  the  conventional  methods 
(359)  suggests  the  necessity  of  improved  methods  in 
physical  diagnosis.  The  viscera  are  dominated  by 
the  vagus  and  when  the  tone  of  the  latter  is  augment- 

13 


Progressive     Sp  ondyl  other  apy 

ed  topographic  percussion  is  facilitated.  The  method 
advocated  by  the  author  is  the  vago-visceral  method 
(321).  Fig.  2,  illustrates  the  accuracy  of  the  latter 
maneuver.  The  aneurysm  and  heart  were  primarily 
outlined  by  Dr.  Geo.  Jarvis,  of  Philadelphia,  and  the 
results  of  percussion  were  corroborated  radiographic- 
ally. 

VAGO-VISCERAL  INSPECTION. — In  thin  subjects  and 
notably  in  children,  one  may  observe  when  intermit- 
tent pressure  is  made  with  the  spondylopressor  (Fig. 
1)  at  the  end  of  forced  expiration  during  'suspended 
breathing  at  the  7th  cervical  spine,  the  borders  of  the 
heart  (page  50),  the  lower  border  of  the  stomach  and 
lower  border  of  the  liver  (in  the  anterior  axillary 
and  parasternal  lines).  Each  time  pressure  is  made 
by  an  assistant  the  stomach  or  liver  is  manifested  by 
a  bulging  or  shadow.  As  a  rule,  in  inspecting  the 
stomach  (the  patient  facing  a  window),  it  is  best  to 
stand  to  the  left  of  the  patient  and  look  downward. 
To  inspect  the  liver,  look  downward  from  the  left 
side.  Painting  the  skin  with  a  saturated  alcoholic 
solution  of  gamboge  will  accentuate  the  shadows  but 
not  the  bulging. 

The  diaphragm  reflex  (550) ),  can  be  seen  in  thin 
subjects  in  the  erect  posture  (side  of  patient  toward 
window  and  observer  with  back  to  light)  when  in- 
termittent pressure  is  made  between  the  2nd  and 
3rd  cervical  spines.  During  inspection  patient 
must  suspend  breathing.  The  foregoing  methods 
are  conducted  with  the  patient  standing. 

VAGO-VISCERAL  PALPATION  OF  THE  HEART. — If  dur- 
ing the  time  an  assistant  makes  intermittent  pressure 
at  the  7th  cervical  spine  with  the  spondylopressor  and 
one  follows  an  intercostal  space  toward  the  borders 
of  the  heart,  the  latter  give  to  the  palpating  finger 
a  sensation  not  unlike  that  which  is  felt  when  the  fin- 
ger is  placed  on  the  masseter  muscle  during  mastica- 

14 


Vago-Visceral      Palpation 

tion.  When  proficiency  is  acquired,  it  is  surprising 
how  effectually  one  may  delimit  the  organ. 

This  maneuver  acquaints  us  with  the  condition  of 
the  myocardium  (471)  which,  if  efficient  gives  a  dis- 
tinct impact  to  the  finger.  Vago-visceral  inspection 
of  the  heart  is  described  on  page  50. 

DIAGNOSIS  OF  INTUITIONAL  ACTS. 

An  interesting  brochure  should  be  dedicated  to  this 
fascinating  subject.  Space  forbids  extensive  discus- 
sion and  it  is  merely  introduced  to  awaken  the  inter- 
est of  others. 

Every  emotion  is  simultaneously  an  instinct,  and 
every  physical  reaction  to  an  emotion  is  the  natural 
expression  of  protection.  Instinct  has  already  been 
discussed  on  page  5. 

In  asthenopia,  eyestrain  is  often  intuitively  re- 
lieved by  stretching  the  neck  (which  increases  vagus- 
tone)  (469),  by  forcible  closure  of  the  eyelids  or  by 
rubbing  the  eyes.  Pressure  on  the  eye  will  augment 
vagus-tone  (443). 

In  cardiac  neuroses,  notably  tachycardia,  patients 
instinctively  execute  certain  maneuvers  (229). 

When  the  neck  of  the  prize-fighter  is  vigorously 
rubbed,  it  augments  the  tone  of  the  heart  through  the 
vagus.  A  veritable  heart  reflex  may  be  elicited  by 
friction  in  the  region  of  the  7th  cervical  spine. 

To  relieve  an  overloaded  stomach  the  Bohemian 
peasantry  place  the  knee  against  the  back  of  a  pa- 
tient seated  upon  a  stool  and  make  counterpressure 
with  the  hands  grasping  the  neck.  The  knee-pressure 
is  made  in  the  region  of  the  5th  dorsal  spine  which 
opens  the  pylorus  (page  82). 

Some  prize-fighters  instinctively  employ  the  liver- 
blow  to  disable  their  opponents.  When  such  a  blow 
is  struck  corresponding  to  the  lower  border  of  the 

15 


Progressive     Spondyl  other  apy 

liver  in  the  para'sternal  line,  a  paralysis  of  the 
splanchnic  nerve  ensues  and  there  is  an  engorgement, 
of  the  splanchnic  blood-vessels. 

The  cognates  of  instinct  are  becoming  rapidly  atro- 
phied from  disuse  and  for  this  reason  the  intuition  of 
animals  is  superior  to  that  of  man. 

In  making  pancreatic  fistulae  in  dogs,  the  after- 
treatment  is  handicapped  by  the  tryptic  digestion  of 
the  skin  around  the  wound.  One  dog  suffering  in 
this  way  kept  on  tearing  down  mortar  from  the  wall 
to  lie  upon  and  thus  relieve  the  condition.  The  in- 
tuitional act  on  the  part  of  the  dog  suggests  a  remedy 
in  the  treatment  of  such  fistula?.  Many  lessons  may 
be  derived  from  the  study  of  animals. 

We  have  always  known  that  the  secretion  of  saliva 
is  a  reflex  action  but  only  recently  do  we  know  that 
the  secretion  of  gastric  juice  is  effected  through  affer- 
ent impulses  from  the  senses  (smell,  sight,  taste) 
passing  reflexly  down  the  path  of  the  vagus.  What 
has  been  revealed  in  animals  respecting  the  secretion 
of  gastric  juice  may  be  utilized  in  practice.  Thus, 
careful  investigations  have  convinced  me  that,  when 
stimulation  of  the  vagus  is  executed  (7th  cervical 
spine),  gastric  juice  is  increased  and  diminished, 
when  the  vagus  is  depressed  (472).  Section  of  the 
vagi  in  animals  prevents  and  their  stimulation  aug- 
ments the  flow  of  gastric  juice  after  an  interval  of 
several  minutes.  Empirical  knowledge  has  been  sub- 
stituted by  scientific  facts  by  animal  observations. 
Food  served  in  an  inviting  way  stimulates  the  gastric 
juice  and  its  quantity  is  determined  by  the  character 
of  the  ingested  food. 

A  meat  diet  provokes  the  most  powerful  and  a  milk 
diet,  the  weakest  'secretion.  Many  vaunted  remedies 
like  alcoholic  preparations,  acids,  alkalies  and  bitters 

16 


Backache      and      Vertebral      Tenderness 

have  no  greater  effect  when  swallowed  in  exciting  the 
flow  of  gastric  juice  than  has  water,  in  fact,  in  many 
instances  they  inhibit  the  flow.  They  act  reflexly  in 
increasing  the  juice  by  their  taste  and  A.  Randle 
Short,  suggests  that  these  time-honored  remedies 
should  be  used  as  a  mouth-wash,  without  swallowing 
them. 

BACKACHE  AND  VERTEBRAL  TENDERNESS. 

Despite  the  fact  that,  this  subject  has  already  been 
discussed  (71,  83,  422),  its  importance  in  diagnosis 
demands  additional  data. 

Tenderness  in  the  spine  is  practically  always  asso- 
ciated with  localized  or  more  diffused  rigidity  and 
must  be  regarded  as  a  protective  reflex  to  give  rest 
to  the  implicated  part. 

The  tissues  involved  may  be : 

1.  Skin  and  subcutaneous   tissues    (wounds,    ab- 
scess) ; 

2.  Muscles,  fasciae  or  nerves  (gout,  rheumatism, 
neuralgia,  traumatism) ; 

3.  Vertebrae   (128,  137),  vertebral  joints   (osteo- 
arthrtis)  and  sacro-iliac  joint; 

4.  Cord  and  meninges  and  spinal  nerve-roots. 
Visceral  diseases  and  backache  also  demand  con- 
sideration. 

Pain  with  tenderness  on  pressure  emphasizes  the 
presence  of  local  disease.  In  referred  pain  (56),  firm 
pressure  evokes  less  pain  than  a  light  touch  (showing 
skin-hyperesthesia) . 

Reaction  of  the  vertebrae  to  pain  may  be  tested 
by  striking  the  spinous  processes  with  a  percussion- 
hammer. 

Reaction  of  the  vertebral- joints  may  be  determined 
by  executing  certain  movements  (41). 

In  vertebral  tuberculosis,  tenderness  is  associated 

17 


Progressive     Sp  o  ndyl  o  therapy 

with  deformity  and  rigidity  of  the  affected  part  and 
the  rigidity  is  accentuated  by  movements.  The  pain 
is  aggravated  when  the  shoulders  or  legs  are  jarred  or 
when  the  cathode  of  a  Galvanic  current  or  a  hot 
sponge  approaches  the  deformity. 

In  rickets  (143),  there  is  no  decided  spinal  tender- 
ness and  the  spinal  curvature  evanesces  when  the 
child  is  suspended  by  the  head  or  arms. 

Secondary  malignant  growths  often  implicate  the 
vertebrae. 

The  Roentgen  rays  are  often  imperative  in  diag- 
nosis but  it  is  in  the  interpretation  of  the  skiagrams 
that  the  greatest  skill  is  displayed. 

We  shall  now  consider  briefly  the  tissues  involved 
in  backache. 

1.  SKIN. — Reference  has  been  made  to  cutaneous 
hyperesthesia  which  is  common  in  the  rachialgia  of 
neurasthenic  and  hysterical  subjects  (70).  Unlike 
the  pain  in  lumbago  which  is  diffused  laterally,  in  ra- 
chialgia the  pain  spreads  upward  in  the  line  of  the 
spine.  The  pain  develops  gradually  and  is  influenced 
by  various  maneuvers  (70).  The  pains  from  which 
the  patient  suffers  may  be  reproduced  by  pressure 
over  the  sensitive  area.  Deformity  is  absent  and 
mobility  is  not  compromised.  When  the  eyes  of  the 
patient  are  closed,  localization  of  pain  and  response 
of  tenderness  to  varying  degrees  of  pressure  with 
the  spondylopressor  (page  9)  is  characteristic. 

Many  neurasthenics  revel  in  their  valetudinarian- 
ism and  though  desirous  of  counsel  do  not  take  it. 
Instruct  such  patients  to  take  a  dose  of  potassium  io- 
did  or  other  drug  (which  can  be  detected  in  the 
urine)  during  a  paroxysm  of  pain  and  on  the  same 
day  determine  its  presence  in  the  urine. 

In  hysteria,  spinal  points  of  tenderness  (like  peri- 

18 


Muscles,    Fasciae    and    Nerves 

plieral  points)  are  painful  to  the  slightest  touch, 
whereas  deep  pressure  if  the  patient  is  diverted  may 
be  painless.  Such  pressure  may  excite  (hysterogenic 
areas)  or  inhibit  (hysterofrenic  areas)  and  hysteri- 
cal attack. 

2.  MUSCLES,  FASCIAE  AND  NERVES. — The  sole  sup- 
ports in  maintaining  the  spine  erect  are  the  muscles  of 
the  back  and  trunk  without  which  support  the  spine 
would  collapse.  The  region  between  the  9th  dorsal 
and  3rd  lumbar  vertebrae  is  the  weakest  part  of  the 
spine.  Sprains  of  the  column  never  assume  any  mag- 
nitude owing  to  the  compact  formation  of  the  spine 
and  a  force  necessary  to  lacerate  the  ligaments  would 
result  in  fracture  and  dislocation  of  the  vertebrae. 
The  latter  condition  without  a  fracture  is  extremely 
rare.  Sprains  are  most  frequent  in  regions  enjoying 
the  greatest  mobility  (cervical  and  lumbar)  whereas 
fractures  occur  in  less  mobile  areas  of  the  spine. 

These  is  perhaps  no  disease  in  our  nosology  more 
frequently  abused  than  "rheumatism." 

Even  lumbago  (84,  92)  is  most  often  a  lumbo- 
abdominal  neuralgia  and  freezing  over  the  vertebral 
exits  of  the  implicated  spinal  nerves  will  at  once 
arrest  the  pain. 

Lumbago  is  bilateral  and  its  diagnosis  in  cases  of 
some  duration  should  not  be  made  until  the  nervous 
system  is  tested  insomuch  as  it  may  be  essentially  a 
symptomatic  condition.  Lumbago  may  be  associated 
with  sciatica  but  more  often  it  is  a  simultaneous 
implication  of  the  spinal  nerves. 

Lumbago  in  a  woman  demands  an  examination  of 
the  pelvic  viscera,  and  of  the  rectum  in  both  sexes. 

In  a  number  of  patients  complaining  of  backache,  I 
have  found  at  the  insertion  of  the  gluteus  maximus 
large  movable  nodules  suggesting  lymph-glands  al- 

19 


Progressive     Spondylotherapy 

though  anatomists  do  not  record  their  location  in  this 
region.  Lymphatic  drainage  from  the  lower  part  of 
the  back  is  through  the  inguinal  glands  (about 
Poupart 's  ligament) . 

3.  VERTEBRAE,  VERTEBRAL  JOINTS  AND  SACRO-ILIAC 
JOINT. — The  vertebrae  may  be  painful  from  trauma- 
tism,  erosion  by  an  aneurysm,  tuberculosis,  malignant 
disease,  infections  (gonorrhea,  pyemia)  and  spondy- 
litis. 

The  role  played  by  uric  acid  in  muscular  and  artic- 
ular pains  (158)  should  be  decided  in  several  days  by 
the  use  of  atophan  which  facilitates  the  elimination 
of  uric  acid  from  the  organism  in  all  gouty  and 
rheumatic  affections.  Doses  of  2  to  3  grams  are  said 
to  eliminate  within  24  hours,  double  and  treble  the 
amount  of  uric  acid  and  occurs  independently  of  the 
fact  whether  purin  or  purin-free  food  is  taken.  The 
spleen  is  a  well-known  reservoir  of  uric  acid  and  after 
concussion  to  elicit  the  spleen  reflex  of  contraction, 
one  can  increase  the  output  of  uric  acid  in  the  urine. 

One  may  estimate  the  excretion  before  and  after 
treatment  by  Gubler's  method.  Stratify  urine  upon 
a  layer  of  nitric  acid  (volume  of  former  to  latter  as 
3:2).  At  the  line  of  junction  of  the  two  fluids  a 
cloudy  ring  of  uric  acid  will  separate  out  in  5  minutes 
or  less  if  uric  acid  is  increased  but  if  diminished,  it 
will  not  appear  until  later.  Phosphotungstic  acid 
solution  is  a  delicate  test  for  uric  acid  in  the  blood.3 

The  movements  of  the  spine  are  chiefly  due  to  the 
23  intervertebral  cartilages  which  constitute  nearly 
one-fourth  of  the  entire  spine. 

No  examination  of  the  back  is  complete  without 
determining  the  mobility  of  the  spine.  Thus,  when 
the  back  is  bent  forward,  the  lumbar  spines  separate 
and  if  the  distance  in  the  erect  posture  between  the 

20 


Vertebrae  and  Vertebral  Joints 

1st  lumbar  and  1st  sacral  spine  is  10  cm.,  when  the 
back  is  bent  forward  it  is  15  cm. 

Osteo-arthritis  (105,401)  is  an  infection  frequently 
overlooked  notwithstanding  its  frequency. 

Some  contend  that  rheumatoid  arthritis  is  a  disease 
distinct  from  osteo-arthritis.  In  the  former,  the  syn- 
ovial  membranes  and  periarticular  tissues  are  affect- 
ed and  in  the  latter,  the  cartilage  and  bone.  Others 
hold  that  both  are  varying  forms  of  the  same  disease. 

Radiographs  are  valuable  in  diagnosis.  Hyper- 
trophy and  overgrowth  of  bone  are  noted  especially 
in  the  spine. 


FIG.  3. — The  Stretcher  of  Cropp,  with  patient  in  the  prone  posture. 

The  cartilage  is  eroded,  disappears,  or  is  replaced 
by  fibrous  tissue  or  bone,  notably  at  the  edge.  The 
overgrowth  of  bone  corresponds  to  the  small  hard 
knobs  at  the  sides  of  the  distal  phalanges»known  as 
H eh er den's  nodes. 

Osteo-arthritis  is  often  the  cause  of  many  intract- 
able spinal  neuralgias,  torticollis,  lumbago  and  sciat- 
ica. 

The  pains  of  this  affection  are  more  frequently 
caused  by  a  neuritis  than  a  neuralgia  due  either  to  an 
extension  of  the  inflammation  to  the  nerve  or  by  pres- 
sure on  the  latter  by  the  overgrowth  of  bone.  Here, 
suspension  (478)  gives  at  least  temporary  relief. 

A  convenient  and  excellent  substitute  for  suspen- 
sion is  "The  Stretcher"  (Fig.  3)  devised  by  David 

21 


Progressive     Sp  o  ndy  1  o  th  er  apy 

Bertram  Cropp.    With  this  apparatus  traction  can 
be  made  in  the  prone  or  recumbent  posture. 

Pain  in  the  sacral  region  (sacralgia)  is  frequently 
caused  by  relaxation  of  the  sacro-iliac  joints  (111). 
In  the  norm,  motion  in  these  joints  is  scarcely  per- 
ceptible and  any  considerable  motion  is  abnormal. 
Motion  may  be  tested  with  the  patient  in  the  prone 
posture  with  the  straight-leg  raising  test  which  tilts 
the  pelvis  forward  or  backward  upon  the  sacrum. 

Motion  is  also  determined  by  having  the  subject 
support  the  body  alternately  on  one  and  then  the  oth- 
er leg.  The  pains  are  not  strictly  local  but  often 
diffused  owing  to  the  relation  of  the  joint  to  the  lum- 
bo-sacral  cord.  From  pressure  on  the  obturator 
nerve,  the  pains  may  be  referred  to  the  hip  or  knee 
(supplied  by  same  nerve). 

While  coccygodynia  (95),  is  in  the  majority  of  in- 
stances a  neurosis  due  as  I  believe  to  some  anomaly 
of  Luschka's  gland  (in  front  of  the  tip  of  the  coccyx), 
it  may  also  be  caused  by  some  disease  of  the  uterus 
and  adnexa  which  drag  on  the  broad  ligaments  with 
drain  on  the  coccygeal  gland  (sacral  portion  of  the 
gangliated  cord) . 

Faulty  posture  (186)  is  also  responsible  for  pains. 
Any  deviation  from  a  well-balanced  position  strains 
the  muscles  and  ligaments  and  alters  the  relationship 
of  the  viscera.  Cure  can  only  be  effected  by  exercise 
and  the  use  of  proper  shoes  and  corsets.  An  effect- 
ive corset  may  also  correct  the  abdominal  ptosis.  In 
connection  with  faulty  posture,  there  is  sacro-iliac 
strain  and  enfeeblement  of  the  long  plantar  arches. 

The  outlines  of  the  abdomen  and  back  may  be  eas- 
ily determined  and  preserved  for  reference  by  per- 
mitting light  to  fall  on  a  large  piece  of  ground-glass 
in  such  a  way  that  a  silhouette  of  the  body-contour 
can  be  drawn  with  chalk  and  then  transferred  to 

22 


FIG.   4. — Normal  or  neutral  type  of  posture.     Distinguishing  features 
are:   (1)  Line  of  gravity  of  body  passes  through  important  pivotal  points; 

(2)  the  pelvis  is  balanced  in  equilibrium  on  the  heads  of  the  thigh  bones; 

(3)  this  relation  of  important  pivotal  points  with  the  line  of  gravity  and 
this    balance    of    the    pelvis    prevents    muscles   and    ligament    strains,    and 

(4)  the  rear  perpendicular  touches  the  middle  back  and  the  buttocks. 
(After  Dickinson  and  Truslow.) 

23 


Progressive     Spondylotherapy 

paper.  This  method  is  the  one  I  employ  in  tracing 
a  struma  (page  73).  In  the  norm,  the  posterior  per- 
pendicular line  touches  the  buttocks  and  the  middle 
back  (Fig.  4)  and  the  abdomen  does  not  protrude 
beyond  a  perpendicular  line  drawn  upwards  from  the 
anterior  surfce  of  the  thighs. 

4.      CORD,  MENINGES  AND  SPINAL  NERVE-ROOTS. —  In 

cord-lesions,  analgesia  includes  deep  as  well  as  su- 
perficial pain  whereas  in  a  peripheral  nerve-lesion, 
superficial  may  be  accompanied  with  deep  hyperal- 
gesia  (page  12).  In  cord-lesions,  if  there  is  any  loss 
to  thermal  stimuli,  all  degrees  of  heat  and  cold  will 
be  lost.  Again,  if  the  lesion  implicates  the  posterior 
columns,  there  may  be  a  loss  of  the  sense  of  passive 
position  and  movement  without  loss  of  tactile,  pain- 
ful or  thermal  stimuli. 

In  cord  and  nerve-root  lesions,  the  distribution  of 
sensory  disturbances  is  quite  different  than  in  impli- 
cation of  the  peripheral  nerves. 

A  zone  of  hyper esthesia  may  be  found  just  above 
the  area  of  anesthesia,  in  growths  of  the  spinal  men- 
inges,  spinal  caries  and  herpes  zoster  due  to  pressure 
or  irritation  of  the  posterior  root-fibers.  According 
to  the  theory  of  diaschisis,  only  a  few  symptoms  are 
the  result  of  the  lesion  itself,  the  balance  are  due  to 
diaschisis,  i.  e.,  functional  shock-like  inhibition  of  un- 
injured distant  areas  produced  by  the  dynamic  in- 
fluences of  a  lesion  anatomically  connected  with  such 
areas.  The  symptoms  due  to  diaschisis  can  disap- 
pear and  are  therefore  in  principle  temporary. 

The  spinal  cord  only  extends  to  the  2nd  lumbar 
vertebra.  Lesions  of  the  lower  part  of  the  cord  may 
implicate  the  cauda  equina  (lumbar,  sacral  and  coccy- 
geal  nerve-roots)  or  the  conus  medullaris  (that  part 
of  cord  below  3rd  sacral  segment). 

In  the  diagnosis  of  the  foregoing  consult  the  table 

24 


Referred      Pain      in      Visceral      Disease 

of  localization  of  the  functions  in  the  segments  of 
the  spinal  cord  (32  et  seq.). 

REFERRED  PAIN  IN  VISCERAL  DISEASE 

This  subject  has  been  discussed  (74). 

Recent  investigations4  have  modified  our  concep- 
tion of  visceral  pain  (415)  with  special  reference  to 
the  peritoneum. 

Franke,  shows  that  the  autonomic  system  (411) 
of  the  abdominal  organs  is  derived  from  the  central 
nervous  system  in  the  mid-brain,  the  medulla,  the 
dorsal  cord,  and  the  upper  part  of  the  lumbar  cord. 
He  divides  the  system  into  four  parts :  ( 1 )  The 
mid-brain  autonome,  represented  by  the  third  cran- 
ial nerve;  (2)  The  bulbar  autonome,  the  seventh, 
ninth,  and  tenth  cranial  nerves;  (3)  The  sympa- 
thetic, and  (4)  the  sacral  autonomes.  Each  fiber 
is  provided  between  the  spinal  cord  and  its  peri- 
pheral end  with  one  ganglion  cell.  They  only  pos- 
sess a  centrifugal  conduction  power,  and  when  the 
organs  supplied  contain  sensory  nerves  the  latter 
are  derived  from  the  cerebro-spinal  system  and 
have  no  connection  with  the  autonomic  system.  The 
abdominal  organs  are  innervated  by  the  vagus,  the 
sacral  autonome  and  the  sympathetic.  Under  ordi- 
nary conditions  the  abdominal  organs  do  not  reveal 
the  least  sensation,  but  under  certain  circumstances 
they  may  be  the  seat  of  severe  pain,  which,  accord- 
ing to  Frohlich  and  Meyer,  is  due  to  the  stimulation 
of  ordinary  spinal  nerves  issuing  from  the  posterior 
spinal  roots.  The  vagus,  the  splanchnics,  and  the 
hypogastric  nerves  are  free  from  any  sensory  fibers. 
Approaching  the  subject  from  the  experimental  side 
he  finds  that  some  difficulty  is  experienced  when  util- 
izing animals  for  the  purpose.  Local  anaesthetics 
have  to  be  avoided,  as  they  induce  a  general  insensi- 
tiveness,  and  it  is  obvious  that  cold  air  produces  a 
loss  of  sensibility  in  regard  to  the  abdominal  organs. 
He,  however,  came  to  the  conclusion  from  the  reli- 
able evidence  available,  that  mechanical  stimuli  to 
the  intestines  produce  pain  in  the  lower  animals,  but 
not  when  applied  to  the  liver,  spleen,  or  pancreas. 
Dogs  are  more  susceptible  than  cats  or  rabbits.  It 
appears  further,  that  the  stomach  of  these  animals  is 

25 


Progressive     Spondylo  therapy 

insensitive,  but  tying  of  vessels  in  connection  with 
the  organ  is  associated  with  pain.  Turning  to  the 
human  subject,  the  experience  of  local  anaesthetics 
permits  of  a  number  of  deductions.  The  parietal 
peritoneum  is  extremely  sensitive,  and  has  the  pow- 
er of  localization  to  some  extent.  The  liver  is 
absolutely  insensitive  to  mechanical  stimuli,  which 
explains  the  painlessness  of  hepatic  affections  un- 
til the  process  involves  the  surface,  and  thus 
the  peritonial  covering.  He  could  not  find  any 
records  with  regard  to  the  sensibility  of  the  human 
spleen  or  pancreas.  The  esophagus  possesses  sen- 
sation for  pain,  warmth,  cold,  and  for  pressure. 
This  sensibility  decreases  downward.  Further, 
he  had  no  hesitation  in  stating  that  pain  is  felt 
in  the  mesentery,  right  up  to  the  intestine.  He 
discusses  at  some  length  the  question  whether  the 
intestine  is  sensitive  or  not,  and  comes  finally  to  the 
conclusion  that  normally  the  gastro-intestinal  canal 
is  insensitive,  in  contrast  to  the  case  of  animals.  He 
shows  that  the  pain  of  supposed  hyperacidity  of  the 
stomach  is  in  reality  due  to  a  gastric  ulcer.  He  fol- 
lows this  up  with  an  analytical  discussion  of  the 
pain  of  colic  etc.,  and  referred  this  pain  to  pulling 
on  the  mesentery,  giving  a  detailed  account  of  the 
mode  of  production.  He  states  that  the  gall  blad- 
der is  wholly  insensitive  to  mechanical  stimuli,  but 
that  the  pain  associated  with  biliary  colic,  etc.,  is  due 
to  the  pulling  on  the  nerves  in  the  neck  of  the  blad- 
der; this  is  supported  by  the  fact  that  ligature  of 
the  cystic  artery  and  the  neck  of  the  gall  bladder 
are  painful  procedures.  The  same  is  true  of  the 
kidneys.  The  urinary  bladder  is  sensitive,  especial- 
ly in  the  trigone,  and  the  floor  is  certainly  sensitive 
to  heat. 

It  is  often  difficult  to  say  whether  an  area  of  verte- 
bral tenderness  (71)  is  due  to  a  neuralgia  of  the  spin- 
al nerves  or  to  visceral  disease.  One  must  of  course 
exclude  all  other  factors  in  the  production  of  pain 
and  remember  that  tenderness  in  the  back  may  impli- 
cate the  skin,  muscles,  joints,  bones,  meninges  or  cord. 

In  vertebral  tenderness  of  visceral  origin  the  fol- 
lowing data  are  available  in  diagnosis : 

26 


Referred      Pain      in      Visceral      Disease 

a.  An  electric  current  (68)  or  persistent  friction 
of  the  skin  over  the  tender  area  causes  a  red  spot  to 
appear  which  is  more  persistent  than  in  the  surround- 
ing area. 

b.  Absence  of  typical  points  douloureux  (185). 

c.  Accentuation  of  vertebral  tenderness  by  manip- 
ulation of  the  suspected  viscus  (75). 

d.  Elicitation  of  dermatomes  (58). 

e.  Segmental-analgesia  of  the  viscera  (376). 

f.  Tenderness  is  superficial  and  if  the  skin  is 
pushed  to  one  side,  deep  pressure  causes  little  or  no 
pain. 

g.  Unlike  the  pain  of  a  neuralgia,  rubbing  the 
part  does  not  evoke  a  localized  spasm  of  the  muscle. 

In  all  true  neuralgic  affections,  the  muscles  inner- 
vated by  the  nerves  show*  a  decided  weakness  almost 
tantamount  to  a  paresis. 

Vertebral  tenderness  of  visceral  origin  is  unaccom- 
panied by  rigidity  (diffused)  or  deformity  of  the  ver- 
tebral column  and  accentuated  movements  (avoiding 
tender  area)  are  not  associated  with  pain.  In  af- 
fectations of  the  heart  and  aorta,  vertebral  tenderness 
or  backache  is  accentuated  by  active  movements  and 
they  are  mitigated  by  diuretin  or  nitroglycerin,  not- 
ably if  the  pains  are  due  to  an  aneurysm  or  coronary 
disease. 

In  esophageal  disease,  pains  are  accentuated  by 
repeated  acts  of  deglutition. 

In  gastric  ulcer,  the  pains  are  worse  after  eating. 

Thus  a  number  of  data  may  be  elicited  from  the 
anamnesis  and  the  execution  of  certain  maneuvers. 
We  must  also  search  for  tender  points  which  are  al- 
most characteristic  of  certain  affections  of  the  vis- 
cera : 

1.  Sub-mammary  tenderness. — Present  in  the  left 
breast  in  the  4th  or  5th  intercostal  space  and  is  a  re- 

27 


Progressive     Spondylotherapy 

flex  effect  of  some  pelvic  affection  (uterus  and  ad- 
nexa). 

2.  Renal  disease. — The  posterior  root  of  the  12th 
nerve  is  associated  with  the  renal  ganglia  of  the  sym- 
pathetic, in  consequence  of  which,  a  tender  spot  at 
the  tip  of  the  12th  rib  or  soft  tissues  contiguous  there- 
to is  found  in  pyelitis  and  nephrolithiasis.  In  affec- 
tions of  the  renal  pelvis  and  ureter,  painful  areas 
are  found  in  the  course  of  distribution  of  the  llth 
dorsal  to  the  2nd  lumbar  nerves.     The  contraction 
of  the  cremaster  muscle  in  renal  colic  suggests  stim- 
ulation of  the  cord  at  the  level  of  the  1st  and  2nd 
lumbar  nerves.    In  testicular  affections,  there  is  a 
tender  area  where  the  cord  passes  into  the  external 
ring. 

3.  Gall-bladder. — Localized    tenderness    at    the 
junction  of  the  upper  and  middle  thirds  of  a  line 
drawn  from  the  9th  rib  to  the  umbilicus  (location  of 
fundus  of  gall-bladder).  Enlargement  of  the  latter 
occurs  in  the  direction  of  this  line.    In  the  norm  the 
neck  of  the  gall-bladder  is  opposite  the  9th  costa 
cartilage  but  it  may  be  as  low  or  lower  than  the  um- 
bilicus when  the  liver  is  enlarged  (597). 

4.  Pancreas. — Tenderness  in  the  mesial  line  one 
inch  above  umbilicus  (Bobson's  point)  is  present  in 
pancreatitis. 

Appendix. — There  may  be  several  points  of  ten- 
derness in  appendicitis  and  ceco-appendicitis ; 

a.  McBurney's  point,  one  and  a  half  inches  from 
the  anterior  superior  spine  of  ileum  on  a  line  toward 
the  umbilcus  (except  when  appendix  is  not  in  normal 
position)  ; 

b.  Monroe 's  point,  at  margin  of  rectus  on  the  same 
line  as  the  former  (location  of  ileocecal  valve)  ; 

c.  Morris's  point,  on  the  same  line  one  and  a  half 
inches  from  umbilicus. 

28 


Diagnosis        of        Hysteria 

In  chronic  appendicitis  the  point  of  Morris  is  usu- 
ally tender,  that  of  Monroe  slightly  and  that  of  Mc- 
Burney  rarely.  In  acute  appendicitis  the  condition 
is  reversed.  A  tender  point  to  the  left  of  the  umbili- 
cus corresponding  to  the  point  of  Morris  on  the  right 
side  is  often  present  in  chronic  salpingitis. 


So  much  excellent  philosophy  has  been  wasted  in 
arriving  at  a  conception  of  hysteria,  that  the  writer 
hesitates  to  express  his  viewpoint  of  this  psychoneu- 
rosis.  Among  the  chief  conceptions  of  the  disease 
are  the  following : 

1.  A  state  in  which  ideas  control  the  body  and 
produce  morbid  changes  in  its  functions  (Mobius). 

2.  A  psychosis  in  which  morbid  states  are  induced 
by  ideas  (Char cot). 

3.  A  mental  condition  with  certain  primary  phe- 
nomena and  certain  secondary  accidental  symptoms. 
The  essence  of  the  primary  phenomena*  is  that  they 
may  be  produced  by  suggestion  and  may  be  made  to 
disappear  by  persuasion  or  technically  pithiatism 
(Babinski). 

4.  Unconscious  fixed  ideas  in  which  a  sexual  fac- 
tor is  concerned  and,  by  translating  the  unconscious 
to  the  conscious,  the  impulsions  which  dominate  the 
patient  may  be  eliminated.  The  sexual  factor  arouses 
an  emotion  which  is  associated  with  some -bodily  or 
verbal  expression.    The  original  emotion  may  pass 
from  view,  but  the  expression  of  the  emotion  lives 
and  recurs  in  consciousness  (Freud). 

From  the  foregoing,  the  following  factors  demand 
brief  analysis:  ideas,  emotions,  and  suggestion. 

IDEAS. — I  have  employed  the  term  ideopath,  to  des- 
ignate an  individual  whose  apparently  sole  affliction 
is  some  morbid  fixed  idea.  A  morbid  idea  may  persist 

29 


Progressive     Spondylotherapy 

even  after  the  cause  which  brought  it  into  existence 
has  passed  away.  The  ideogenic  factors  may  be  many 
but  there  is  no  idea  in  the  mind  which  was  not  before 
in  the  senses.  ' '  The  idea  of  a  disease  produces  disease 
in  direct  proportion  to  its  definiteness  and  in  inverse 
proportion  to  the  strength  of  the  idea  opposing  it." 
An  idea  "generates  its  actuality."  If  an  individual 
has  only  one  idea,  the  latter  will  express  itself  in  some 
kind  of  external  motion.  The  brain-cells  concerned  in 
idea-formation  will  discharge  their  force  without  re- 
straint. Man  is  not  only  an  ideo-motor  but  an  ideo- 
idea  being.  Thus  with  two  ideas,  one  can  inhibit  the 
action  of  the  other.  Thought  like  force  pursues  the 
path  of  least  resistance,  and  with  the  repetition  of 
thought  a  habit  is  engendered  which  so  masters  the 
mind  that  the  idea  becomes  pathologic,  and  is  awak- 
ened into  activity  by  the  most  trivial  suggestions. 

EMOTION. — This  is  a  state  of  feeling — fear,  grief, 
anger,  joy — which  is  initiated  like  a  brain-storm,  and 
in  its  tumultuous  force  creates  energetic  disturbance 
of  the  entire  organism.  The  emotions  are  physiolog- 
ically manifested  by : 

1.  Muscular  expression. 

2.  Bodily  expression. 

An  idea  is  so  associated  with  emotion  that  no  ab- 
sorbing idea  can  be  entertained  without  a  change  of 
the  entire  body  to  harmonize  with  it. 

Our  emotions  have  a  rhythmic  undulation  depend- 
ent on  the  state  of  body  raising  or  depressing  the  stan- 
dard of  vitality.  All  feeling  is  necessarily  mental, 
yet  there  are  physical  feelings  originating  from  sensa- 
tions derived  from  the  tissues  and  organs  of  the  body. 

One  may  objectively  demonstrate  the  influence  of 
emotions  on  the  viscera  (203). 

30 


Suggestion 

Emotions  are  often  an  expression  of  fatigue  or  are 
fatigue-producing. 

The  Lang-James  theory  refers  the  origin  of  our 
emotions  to  an  organic  disturbance  reflexly  aroused 
by  the  stimulus  of  the  object ;  in  other  words  it  is  not 
the  object,  but  the  bodily  commotion  which  the  object 
excited. 

In  hysteria  one  often  finds  physical  or  emotional 
shocks  or  a  combination  of  both  as  exciting  causes. 

SUGGESTION. — An  emotional  reaction  and  suscepti- 
bility to  suggestion  exist  in  varying  degrees  even  in 
the  norm.  In  children,  this  condition  is  referred  to 
as  the  "physiological  hysteria"  of  childhood.  If,  how- 
ever, this  condition  of  suggestion  and  reaction  to 
emotions  should  appear  in  adults,  it  would  be  regard- 
ed as  a  manifestation  of  hysteria. 

If  auto-suggestion  is  a  peculiarity  of  hysteria  ac- 
cording to  Babinski,  then  no  one  is  exempt  from  the 
disease.  If  a  physician  dwells  too  long  on  the  exam- 
ination of  an  organ,  it  is  not  unnatural  for  him  to 
create  fixed  ideas  which  graduate  into  obsessions,  so 
that  the  patient  carries  his  organ  in  his  head,  and 
from  the  latter  citadel,  viscero-sensorial  reflexes  em- 
anate. All  hysteric  symptoms  are  made  conspicuous 
by  the  fact  that  they  depend  and  react  to  psychic  in- 
fluence and  the  term  " impossible"  must  be  "erased 
from  the  pathology  of  hysteria." 

The  symptoms  of  the  disease  show  mobility,  varia- 
bility and  incertitude.  The  disease,  observed  Lasegue, 
is  a  basket  into  which  we  throw  the  papers  that  we  do 
not  know  how  to  classify. 

Hysteria  counterfeits  organic  disease  to  such  a  de- 
gree that  often  the  only  thing  you  can  positively  ex- 
clude in  hysteria  in  a  female  is  an  enlarged  prostate 
and  in  a  male,  a  diseased  uterus. 

31 


Progressive     Spondylotherapy 

When  a  symptom  can  neither  be  willed  nor  simulat- 
ed, it  speaks  for  organic  against  functional  nervous 
diseases.  Such  unwilled  phenomena  are:  lost  knee- 
jerk,  reaction  of  degeneration,  'Babinski  toe-sign, 
changes  in  optic  nerve,  hemianopsia,  decided  pupil- 
lary changes,  unilateral  vocal  cord  paralysis,  facial 
paralysis,  ankle  clonus  and  incontinence  of  urine  and 
feces. 

Suggestion  is  common  to  all  psychoneuroses  and 
is  not  limited  to  hysteria.  The  latter  is,  however,  facile 
princeps  the  paragon  of  simulation.  Let  us  not  as- 
sume for  a  moment  that  it  stands  alone  in  its  majes- 
ty, completely  isolated  from  other  diseases;  on  the 
contrary,  it  permeates  in  various  dilutions  every 
pathologic  picture,  and  no  morbid  tableau  is  com- 
plete without  it.  There  is  such  a  disease  as  hysteria 
but  there  are  also  hysteroid  diseases.  Organic  diseases 
may  parade  in  the  guise  of  hysteria  and  before  the 
diagnosis  of  hysteria  is  justified  organic  factors  must 
be  excluded.  It  is  sufficient  evidence  of  our  ignor- 
ance to  make  the  diagnosis  of  hysteria  but  it  is  worse 
when  it  doesn't  exist. 

The  symptomatology  of  hysteria  implicates  chiefly 
tissues  innervated  by  the  sympathetic  system. 

A  characteristic  feature  of  the  disease  is  a  lack  of 
inhibition,  the  patient  reacting  to  stimuli,  is  exces- 
sively emotional  and  changeable  in  disposition. 

Investigations  show  that  emotional  excitement  aug- 
ments adrenal  and  thyroid  secretion  which  by  depres- 
sing the  tone  of  the  vagus  (the  nerve  through  which 
the  emotions  play  their  chief  role)  stimulate  the  sym- 
pathetic nerves. 

There  is  a  certain  inconsistency  in  our  conception 
of  hysteria  when  we  recognize  it  as  a  disease  in 
which  will  evokes  morbid  changes  in  function  and  ex- 

32 


Suggestion 

pect  patients  to  control  their  symptoms  by  exercise  of 
the  will.  The  fact  is,  that  the  hysterical  symptoms  are 
caused  by  irritation  of  the  sympathetic  system  and 
are  not  under  the  influence  of  the  will. 

Man  is  an  automaton  with  a  dual  mentality.  The 
mind  is  one,  but  a  part  of  it  is  always  conscious  and 
another  part  is  never  illuminated  by  consciousness. 
The  two  minds  have  been  differentiated  into  objective 
and  subjective  minds. 

The  former  or  supra-conscious  mind  takes  cogni- 
zance of  the  objective  world  through  its  media  of  ob- 
servation, the  senses,  and  represents  the  supreme 
function  of  reasoning;  it  is  the  mind  of  intelligence. 
The  subjective  or  subconscious  mind  perceives  by  in- 
tuition independent  of  the  senses  and  is  the  abode  of 
memory  and  the  emotions.  In  this  subconscious  or 
subliminal  mentality,  the  phenomena  of  vegetative 
life,  respiration,  circulation,  nutrition,  etc.,  are  pro- 
duced without  voluntary  effort. 

When  the  sympathetic  nervous  system  is  irritated, 
it  is  the  subconscious  mind  which  perceives  the  irrita- 
tion and  it  is  likewise  this  mind  which  is  amenable  to 
suggestion.  When  these  subconscious  sensations  are 
translated  into  consciousness,  there  is  a  reaction  on 
the  part  of  the  cerebrospinal  system  which  reaction 
assists  in  completing  the  picture  of  the  hysterical 
condition. 

Let  us  draw  on  positive  data  in  support  of  our  view- 
point of  hysteria.  In  the  norm  the  vagal  and  sympa- 
thetic fibers  are  in  physiologic  antagonism.  Vagus 
tone  is  diminished  by  sympathetic  stimulation  and 
conversely,  sympathetic  tone  is  diminished  by  vagus 
stimulation. 

The  ever  changing  bizarre  and  protean  pictures 
of  hysteria  and  other  affections  are  due  to  the  state 
of  psycho-vagus  tone  (466). 

33 


Progressive     Spondylotherapy 

In  every  organism  there  is  a  vulnerable  point  and 
it  is  in  the  latter  that  symptoms  predominate  (Vide 
also  exophthalmic  goitre,  page  71.) 

By  aid  of  the  spondylopressor  (Fig.  1),  it  may  be 
shown  that  in  hysteria,  the  tone  of  the  vagus  is  de- 
pressed. This  depression  may  involve  individual  or- 
gans or  it  may  compromise  all  the  branches  of  the 
vagus.  This  condition  may  be  reproduced  temporar- 
ily in  susceptible  subjects  by  adrenalin  (page  9).  Pil- 
ocarpin  (451),  by  increasing  vagus-tone  may  arrest 
a  paroxysm  of  hysteria  or  ameliorate  symptoms  of 
this  affection.  Barotherapy  may  likewise  improve 
(469)  or  accentuate  (472)  the  symptoms. 

I  have  frequently  noted  in  children  during  attacks 
suggestive  of  hysteria,  an  enlarged  thyroid. 

Amblyopia,  narrowing  of  the  visual  field  and  dis- 
turbance or  loss  of  the  vision  of  colors  (dyschroma- 
topsia)  are  often  encountered  among  hystericals  and 
they  may  be  reproduced  as  I  have  shown  (469)  by  di- 
minishing vagus-tone.  The  same  refers  to  audition 
(499). 

When  symptoms  embrace  the  cerebro-spinal  sys- 
tem without  tangible  reasons  for  their  existence,  the 
presence  of  an  irritable  segment  of  the  cord  made  so 
by  viscero-sensory  reflexes  may  be  surmised. 

Let  us  suppose  that,  in  consequence  of  diminished 
vagus-tone,  there  is  a  dilatation  of  the  heart  and  aorta 
and  the  patient  suffers  from  pains  along  the  ulnar 
border  of  the  arm  with  cutaneous  hyperesthesia.  in 
the  same  area.  Here,  one  must  assume  an  irritable 
cord-segment  and  the  pains  which  are  essentially  rad- 
icular  are  referred  to  the  first  and  second  dorsal 
areas. 

Viscero-motor  (417)  and  other  reflexes  may  be  sim- 
ilarly explained. 

34 


Suggestion 

Many  of  such  reflexes  are  really  protective  and 
may  account  for  the  so-called  deception,  mimicry  and 
simulation  of  hystericals.  This  protective  mimicry 
is  a  nervous  instinct  not  unlike  that  observed  in 
insects  which  when  resting  resemble  the  leaves  of 
plants  or  those  which  appear  dead  in  the  presence  of 
animals  who  prey  on  them  but  eschew  their  inanimate 
bodies. 


35 


Progressive     Spondylotherapy 


CHAPTER  II. 

GENERAL  REFLEXO-THERAPY. 

IRRATIONALITY       OF        EXCLUSIVISM— PSYCHROTHERAPY— REIN- 
FORCEMENT OF  THE  VERTEBRAL  REFLEXES — PHARMACOLOGIC 
REINFORCEMENT— CALCIUM  THERAPY— EXERCISES. 
/ 

It  must  be  again  emphasized  although  I  have  done 
so  repeatedly  that,  vertebral  reflexo-therapy  or  cen- 
trotherapy,  if  one  desires  to  so  call  it  is  only  one  of 
many  methods  for  curing  disease. 

If  there  weren't  many  paths  leading  to  cure,  there 
wouldn't  be  hydropaths,  allopaths,  homeopaths  and 
other  kinds  of  paths.  One  may  enumerate  seventy  va- 
rieties of  tuberculin,  yet  the  sponsor  claims  sover- 
eignty for  his  particular  variety.  In  treatment,  the 
old  rule  of  "curare,  cito,  tute  et  jucunde"  (to  cure,  to 
do  so  quickly,  safely  and  pleasantly)  must  be  concil- 
iated and  above  all,  "Nur  nicht  schaden"  (only  do  no 
harm).  The  average  patient  is  not  so  much  concern- 
ed about  what  he  has,  as  by  what  he  thinks  he  has.  In 
imaginary  diseases  he  believes  too  much  and  does  not 
believe  enough  in  real  diseases.  There  is  always  a 
psychic  factor  in  treatment  and  the  judicious  physi- 
cian combines  psychics  and  physics. 

The  iconoclasts  in  medicine  are  usuaally  extrem- 
ists who  substitute  nothing  for  what  they  destroy. 

Cure  signifies  nothing  when  unaccompanied  by 
scientific  proof,  but  cure  is  a  good  thing  and  the  pa- 
tient wants  it.  In  a  recent  editorial  on  "Suggestion 
in  hyperthyroidism."  cures  are  cited  which  were  ef- 
fected by  nasal  operations,  despite  the  fact  as  the 
writer  assumes,  the  reports  ' '  do  not  serve  to  alter  the 

36 


Psychrotherapy 

status  of  hyperthyroidism  or  its  connection  with  some 
definite  disturbance  of  glandular  metabolism." 

It  is  quite  true  than  many  remedies  and  methods  of 
treatment  when  first  employed  are  effective  and  later 
prove  useless.  It  is  equivalent  to  saying  that  the  cal- 
omel of  one  physician  is  more  effective  than  that  of 
another.  To  deny  that  a  nasal  operation  is  theoretic- 
ally ineffective  is  to  deny  the  important  role  played 
by  reflexes  in  the  etiology  and  cure  of  disease.  Refer- 
ence, on  page  74,  to  the  author's  methods  of  diagnos- 
ing and  treating  exophthalmic  goitre  is  an  attempt  to 
place  our  methods  on  a  mathematical  basis. 

Exclusive  methods  of  treatment  suggest  charla- 
tanry. 

BSYOHROTHEBAPY* 

The  employment  of  cold  (also  known  as  cry  mo- 
therapy)  as  a  remedial  measure  has  already  been 
discussed  (172,  182,  186).  It  is  one  of  our  most  ex- 
peditious curative  agents  but  unfortunately  least  em- 
ployed. In  our  method  of  freezing,  the  reaction  does 
not  exceed  capillary-dilatation  and  erythema.  There 
may  be  noted  microscopically,  a  diapedesis  of  leu- 
cocytes with  some  swelling  of  the  connective  tissue- 
cells.  No  doubt  phagocytosis  plays  an  important 
part  in  cure.  The  tremendous  edema  and  destruction 
of  tissue  when  liquid  air  or  carbon  dioxid  snow  is 
used  is  never  observed. 

There  is  hardly  a  week  that  one  does  not  see  some 
unfortunate  patient  who  has  resisted  all  methods  of 
treatment  and  yet,  after  a  single  freezing  at  the 
proper  area,  immediate  relief  is  obtained.  It  is  true, 
that  in  some  cases  freezing  is  employed  but  always  at 

*The  employment  of  cold  as  a  remedial  measure  in  the  treatment  of 
pain  was  first  reported  in  1882,  in  my  inaugural  dissertation.  I  observed 
its  use  in  the  extraction  of  teeth  during  the  time  I  was  engaged  in  the 
study  of  dentistry. 

37 


Progressive     Spondyl  o  therapy 

a  point  remote  from  the  site  of  the  lesion.  Two  re- 
cent incidents  may  be  cited : 

Patient  had  her  ovary  and  later,  her  Fallopian  tube 
removed  for  severe  abdominal  pains  which  had  per- 
sisted for  three  years.  The  condition  was  a  lumbo-ab- 
dominal  neuralgia  which  yielded  at  once  to  several 
freezings  over  the  vertebral  exits  of  the  implicated 
nerves. 

Patient  had  severe  pains  in  the  left  arm  for  two 
years.  Skiagrams  demonstrated  a  cervical  rib  to 
which  the  pains  were  attributed  and  an  operation  was 
advised.  It  was  a  case  of  cervico-occipital  neuralgia 
and  yielded  to  two  freezings. 

To  illustrate  the  results  of  freezing,  in  the  practice 
of  other  physicians,  I  shall  cite  several  instances  re- 
ported by  Dr.  W.  T.  Baird,  of  El  Paso,  Texas,  in  a  re- 
cept  paper  read  before  "The  American  Association 
for  the  study  of  Spondylotherapy:" 

Case  I.  Suffered  for  two  years  with  excruciating 
pain  in  toe.  "My  treatment  gave  no  relief  until 
Abrams'  method  of  congelation  was  brought  to  my  at- 
tention." A  sensitive  point  at  the  sacro-sciatic  notch 
was  frozen  with  complete  relief  after  two  treatments. 

Case  II.  Constant  and  severe  pains  in  left  mam- 
mary region.  Diagnosis  made  of  phthisis.  Intercostal 
neuralgia  found  and  cure  after  two  freezings.  Gained 
10  pounds  in  one  month.  Pseudo-phthisis  is  not  in- 
frequent (439). 

Case  III.  Excruciating  pains  in  frontal  region  for 
sixteen  years.  Had  all  kinds  of  treatment  including 
removal  of  a  supposed  abdominal  growth  without  re- 
lief. With  the  radicularpressor  one  could  reproduce 
the  pains  from  which  the  patient  suffered.  Twelve 
treatments  by  freezing  over  the  sensitive  vertebral 
exits  of  the  upper  cervical  nerves  sufficed  to  cure.  Be- 
fore treatment  she  was  kept  constantly  stupefied  by 

38 


Psych 


o    t    h 


a    p    y 


morphin.  In  this,  as  well  as  similar  cases,  the  cer- 
vical muscles  were  rigid. 

Case  IV.  Patient  with  pain  in  left  mammary  re- 
gion. Has  a  valvular  cardiac  lesion  for  ten  years,  to 
which  pain  was  attributed.  Speedy  relief  followed 
freezing.  The  interest  in  this  case  lies  in  the  fact  that 
a  tachycardia  from  which  she  suffered  was  equally 
cured. 

Dr.  W.  T.  Baird,  employs  the  following  method  of 
freezing :  A  piece  of  ice  terminating  in-a  conical  point 
is  held  in  the  hand  by  aid  of  a  towel.  The  conical  point 


FIG.  6. — Appurtenances  necessary  for  executing  freezing-  according  to 
th«  method  of  Dr.  G.  Baert;  brass-box,  tin-funnel  and  wooden  plunger. 

is  dipped  into  common  salt  and  then  it  is  pressed 
against  the  vertebral  point  of  tenderness  for  about 
three  minutes.  After  its  removal,  a  cup-shaped  de- 
pression is  left  and  this  is  frozen  with  commercial 
ether  for  3  minutes  longer.  This  method  is  tanta- 
mount to  reinforced  freezing  (173). 

Dr.  G.  H.  Baert,  of  Grand  Rapids,  who  could  not 
obtain  satisfactory  results  from  freezing  with  ether 
owing  to  the  absence  of  compressed  air  in  his  office 
devised  the  following  method.  Finding  that  carbon 
dioxid  snow  as  conventionally  employed  was  too  se- 

39 


Progressive     Spondy  1  oth  er  apy 

vere,  he  found  that  by  confining  it  in  a  metallic  box 
(Fig.  5),  he  was  able  to  keep  it  under  perfect  control. 

The  snow  is  first  collected  in  a  chamois  skin-bag 
from  a  cylinder  in  the  usual  way.  Then  it  is  poured 
into  the  brass-box  through  a  tin-funnel.  Next  the 
snow  is  compressed  with  the  wooden-plunger  by 
kand  (compressed  by  hammer,  the  snow  loses  ite 
freezing  properties).  Now  wet  a  towel  and  press  it 
against  the  bottom  of  the  box  containing  the  snow. 
The  towel  freezes  to  the  box  in  2  seconds  at  which 
time  it  is  ready  to  press  against  the  sensitive  verte- 
bral points.  By  placing  a  dry  towel  over  a  portion  of 
the  freezing  surface,  one  can  limit  the  freezing  to  any 
point  desired. 

For  deep  freezing  a  dry  towel  is  interposed  be- 
tween the  skin  and  box  and  pressure  is  made  for  1A  to 
l/2  minute ;  *.  e.,  until  the  deeper  tissues  are  cooled,  af- 
ter which  a  moist*  towel  is  used  according  to  the  for- 
mer method.  No  vesication  nor  other  untoward  ef- 
fect follows  either  method. 

The  brass  box  (covered  with  a  wet  towel)  should  be 
pressed  on  the  selected  spot  for  about  4  seconds,  then 
removed  until  the  whiteness  due  to  the  freezing  is  re- 
placed by  hyperemia  and  the  process  may  be  repeated 
several  times. 

The  author  finds  no  difficulty  in  freezing  with  an 
ordinary  atomizer  with  metallic  fittings  provided  a 
good  preparation  of  ether  is  obtainable  (173). 

REINFORCEMENT  OF  THE  VERTEBRAL  REFLEXES. 

In  the  spinal  cord,  there  are  centers  for  the  con- 
traction and  dilatation  of  viscera.  In  the  norm,  these 
centers  are  in  physiologic  antagonism.  When  neither 
reflex  predominates  a  reflex  equilibrium  is  establish- 
ed. The  moment  one  reflex  gains  the  ascendancy  over 
its  antagonist,  they  become  disequilibrated.  Each 

40 


Reinforcement  of  the  Vertebral   Reflexes 


segment  of  the  cord  is  connected  with  fibers  from  the 
brain  which  subserve  the  function  of  reflex  inhibi- 
tion. The  inhibitory  fibers  run  in  the  pyramidal 
tracts  (Fig.  6). 


ANATOMY   AND   PHYSIOLOGY 


FIG.  6 — Diagram  of  Pyramidal  Tract  and  its  course  through  the  brain 
and  cord  (after  Stewart). 

The  latter  convey  voluntary  motor  impulses  down- 
ward from  the  motor  cortex  toward  the  anterior 
cornua. 

If  the  inhibitory  fibers  are  irritated,  the  reflexes 
are  impaired  owing  to  stimulation  of  inhibition  and 
if  destroyed,  the  reflexes  are  accentuated. 

Clinically,  one  may  observe  that,  when  one  reflex  is 
pathologically  exalted,  stimulation  of  its  counter-re- 
flex does  not  show  the  same  effects  as  obtained  in  the 


norm. 


41 


Progressive     Spondylotherapy 

It  occurred  to  me  that,  if  one  could  temporarily 
put  one  reflex  out  of  commission,  stimulation  of  the 
counter-reflex  would  prove  more  potential  in  its  ef- 
fects. 

Let  us  take  the  pupil  as  a  paradigm.  Its  sphincter  is 
supplied  by  the  myotic  tract  which  has  its  origin  in 
the  oculomotor  nucleus.  If  this  tract  is  stimulated  the 
pupil  contracts  (myosis)  and,  if  divided,  the  pupil 
dilates  (mydriasis). 

Opposed  to  this,  is  the  mydriatic  tract  supplying 
the  dilator  pupillaB  (Fig.  19).  Stimulation  of  this 
tract  causes  mydriasis  and  if  divided,  myosis. 

The  antagonistic  tonus  of  these  two  tracts  belong- 
ing to  the  autonomic  system  (412)  maintains  the  bal- 
ance of  the  pupil.  Concussion  or  pressure  at  the  7th 
cervical  spine  stimulates  the  autonomic  system 
through  the  vagus  but  such  stimulation  does  not  con- 
tract the  pupil  owing  to  the  antagonistic  action  of  the 
dilator  fibers.  If  one  inhibits  the  action  of  the  dilator 
tract  (pressure  between  the  3rd  and  4th  dorsal 
spines),  concussion  of  the  7th  cervical  spine  will 
cause  the  pupil  to  contract. 

Pressure  not  exceeding  one-half  minute  stimulates 
but  when  the  pressure  exceeds  one  minute  the  oppo- 
site action  ensues. 

One  may  make  pressure  with  the  radicularpressor 
(649),  with  the  instrument  shown  in  fig.  7  or  a  special 
apparatus  (478).  The  latter  (Fig.  7)  is  only  available 
for  pressure  from  the  3rd  dorsal  spine  downwards. 

Suppose  we  are  dealing  with  a  disease  caused  by 
vagus-hypertonia  (479).  Let  us  take  asthma.  If  the 
vagus  is  depressed  in  the  norm  by  concussion  between 
the  3rd  and  4th  dorsal  spines  (495),  a  retraction  of 
the  lower  lung-border  may  be  determined  by  percus- 
sion. If,  however,  pressure  exceeding  one-minute  is 
made  at  the  7th  cervical  spine,  there  is  no  longer  any 

42 


Reinforcement  of  the  Vertebral  Reflexes 

opposition  to  the  lung  reflex  of  contraction.  Now 
again  make  brief  pressure  or  concussion  between  the 
3rd  and  4th  dorsal  spines  and  it  will  be  found  that  the 
retraction  of  the  lung-border  is  accentuated. 

In  the  treatment  of  asthma,  pressure  is  maintained 
for  5  minutes  at  the  7th  cervical  spine  before  brief 
seances  of  stimulation  are  executed  in  the  paraverte- 
bral  region  between  the  3rd  and  4th  dorsal  spines. 


FIG.  7 — Apparatus  available  for  pressure  from  the  3rd  dorsal  spine 
downward  and  used  for  reinforcing  reflexes.  A,  attachments  for  diffused, 
and  B,  for  localized  pressure. 

One  fact  deserves  mention  in  asthma.  Adrenalin 
chlorid  (314)  is  only  employed  to  check  paroxysms. 
Having  determined  its  action  (314),  I  employ  it  as  a 
curative  agent  as  well  by  giving  daily  hypodermatic 
injections  in  the  interparoxysmal  periods. 

43 


Progressive     Sp  on  dylo  therapy 

Suppose  the  disease  is  caused  by  vagus-hypotonia 
(500),  for  instance,  an  aortic  dilatation.  Pressure  for 
5  minutes  is  made  between  the  3rd  and  4th  dorsal 
spines  before  stimulation  of  the  7th  cervical  spine  is 
attempted. 

PHARMACOLOGIO  REINFORCEMENT   OF  THE   REFLEXES. 

It  has  already  been  observed  (page  41)  that  the 
brain  exercises  an  inhibitory  mfluence  on  the  spinal 
reflexes.  We  know  that,  the  mind  can  inhibit  or  dis- 
turb certain  habitual  and  unconscious  actions.  Con- 
scious attention  in  disturbing  reflexes  is  illustrated  by 
the  story  of  the  centipede.  The  latter  was  asked  how 
he  could  walk  with  all  his  hundred  legs  and  in  at- 
tempting to  explain  its  simplicity  became  so  involved 
that  he  was  unable  to  move  at  all. 

In  lateral  sclerosis,  the  lateral  columns  including 
the  pyramidal  tracts  degenerate  so  that  the  inhibitory 
path  from  the  brain  to  the  cord  is  destroyed.  Reflex 
irritability  is  so  accentuated  that  slight  stimulation, 
as  the  movement  of  the  bed-clothes  suffices  to  evoke 
convulsive  spasms  of  the  legs. 

By  aid  of  scopolamin  anesthesia,  cerebral  inhibi- 
tion may  to  a  certain  extent  be  eliminated. 

Even  when  small  doses  of  the  drug  are  given,  one 
may  elicit  the  Babinski  reflex  (15). 

In  non-hypnotizable  subjects,  I  have  often  em- 
ployed scopolamin.  Suggestions  made  in  this  state  are 
realized  after  awakening,  as  in  hypnotism. 

To  accentuate  the  spinal  reflexes,  it  is  not  necessary 
to  give  the  drug  to  produce  amnesia  or  unconscious- 
ness :  only  give  enough  to  produce  drowsiness  or  suffi- 
cient to  elicit  the  Babinski  reflex  which  is  accomplish- 
ed with  comparatively  small  doses.  In  the  majority 

44 


Calcium       Therapy 

of  cases  it  may  be  given  per  os  combined  with  mor- 
phin  (scopolamin,  1/150  grain,  morphin,  1/6  grain). 

CALCIUM  THERAPY 

My  only  excuse  for  discussing  this  subject  is  to 
direct  attention  to  an  important  phase  of  medicine 
ignored  in  our  text-books,  and  because  this  therapy 
may  be  used  as  an  adjuvant  measure  in  aneurysms 
and  exophthalmic  goitre. 


FIG.  8. — Normal  human  blood  showing  crystals,  prepared  with  the 
calcimeter,  x  450. 

Sir  James  Barr,  and  Dr.  W.  Blair  Bell,  of  Liver- 
pool, have  been  prominently  identified  with  the  re- 
cent development  of  this  therapy.  The  essential  bio- 
chemical processes  in  calcium  metabolism  are  little 
understood.  Our  calcium  supply  is  furnished  with 
food  and  water  and  abnormally  from  what  is  stored 
in  the  tissues,  especially  the  bones. 

Calcium  subserves  the  follo.wing  objects: 

1.  Building  up  of  skeleton  and  tissues ; 

2.  Maintaining  the  movements  of  involuntary  and 
preserving  the  normal  irritability  of  voluntary  mus- 
cles; 

3.  Controlling  nervous  excitability; 

4.  Influencing  the  functions  of  reproduction ; 

45 


Progressive     Spondylotherapy 

5.     Promoting  the  coagulation  of  blood; 

Calcium  is  excreted  by  the  alimentary  tract  and 
the  urinary  and  genital  systems. 

One  determines  calcium  metabolism  by  estimating 
the  relative  quantity  of  calcium  in  the  blood  (Fig.  8) 
and  the  excretory  ratio  by  the  amount  in  the  urine.* 
Thus,  if  the  blood  calcium  index  is  high  and  the  urin- 
ary calcium  excretion  is  high,  too  much  is  absorbed  or 
if  the  blood  shows  a  low  and  the  urine  a  high  index, 
too  much  is  excreted. 

Calcium  chlorid  increases  the  coagulability  of  the 
blood  and  is  indicated  to  check  profuse  menstruation, 
hemorrhages  and  other  conditions  demanding  an 
hemostatic. 

Chilblains,  uticaria  and  many  other  affections  have 
yielded  favorably  to  calcium  therapy.  Tetany,  laryn- 
gismus  stridulus  and  infantile  convulsions  are  favor- 
ably influenced. 

Lime  salts  have  also  been  used  in  exophthalmic 
goitre  and  aneurysms  (page  71).  Headaches  and  neu- 
ralgias due  to  deficient  coagulability  of  the  blood  are 
relieved  by  calcium  salts.  In  such  cases,  potassium 
citrate  will  precipitate  an  attack  for  it  is  known  that 
citric  acid  diminishes  blood-coagulability. 

Coagulation  time  of  the  blood  may  be  determined 
by  placing  several  drops  of  blood  upon  slightly  warm- 
ed microscopic  slides  which  at  varying  intervals  are 
tilted  upward  until  they  appear  as  in  fig.  9.  In  the 
norm  coagulation  by  this  method  should  occur  in 
from  2/^-5  minutes. 

Observations  indicate  that  pregnancy  is  terminat- 
ed when  the  fetus  ceases  to  absorb  or  receive  calcium 
salts  from  the  mother's  blood. 

Calcium  salts  have  been  discredited  because  given 

•Estimation  of  calcium  salts  in  the  blood  and  urine  is  effected  by 
Blair  Bell's  ealcimeter. 

46 


E 


x 


s 


in  unabsorbable  form.  The  "Mistura  Calcii  lactatis 
recentis"  of  Bell,  is  the  best  method  of  administra- 
tion; 

Pure  concentrated  lactic  acid,  200  grs.,  Precipitat- 
ed caleiam  carbonate  about,  75  grs.,  to  which  are  add- 
ed 8  minims  of  chloroform  in  8  ounces  of  distilled 
water.  Each  fluid  ounce  contains  29  grains  of  hy- 
drous calcium  lactate. 

The  dose  is  one  and  one-half  to  three  ounces  every 
night  or  every  other  night  and  should  be  taken  on  an 
empty  stomach  before  retiring. 


PIG.  9. — A,  incomplete  coagulation  (tear-shaped  drop);  B,  complete 
coagulation  (convex  drop.) 

EXERCISES. 

Exercises  are  employed  for  developmental  or  edu- 
cational purposes,  to  maintain  physical  vigor  and  to 
correct  special  pathologic  conditions. 

The  latter  is  known  as  corrective  or  therapeutic 
physical  training. 

My  real  object  in  considering  this  subject  is  to  di- 
rect attention  to  a  neglected  field  in  the  study  of  ex- 
ercises on  visceral  tone  (479). 

Definite  movements  of  the  vertebral  column  make 
traction  on  specific  spinal  nerves  and  such  move- 
ments may  be  utilized  for  weal  or  woe  (547). 

47 


Progressive     Spondylotherapy 

My  time  has  been  too  limited  to  classify  my  results 
concerning  such  vertebral  action  and  I  trust  that, 
having  made  the  suggestion,  it  may  be  exploited  by 
another  to  some  advantage. 

It  has  already  been  shown  how  one  may  augment 
vagus-tone  by  exercise  of  the  neck-muscles  (228,  447). 

To  decrease  vagus-tone  in  diseases  caused  by  vagus- 
hypertonia,  traction  must  be  made  on  the  spinal 
nerves  corresponding  to  the  3rd  and  4th  dorsal  spines 
which  depress  vagus-tone. 

Thus  in  asthma,  which  is  caused  by  vagus-hyper- 
tonia,  the  patient  leans  far  forward  with  arm  extend- 
ed and  hand  grasping  a  support,  whereas  the  other 
arm  is  forcibly  extended  in  a  lateral  direction  by  an 
assistant  (Fig.  10). 


FIG.   10. — Exercise  for  reducing  vagus-tone. 

To  avoid  exhausing  the  reflex,  the  exercise  must  be 
of  short  duration  and  frequently  repeated. 

As  an  index  of  its  proper  execution  there  should  be 
a  retraction  of  the  lower  lung-border  (473). 

To  evoke  the  intestinal  reflex  of  contraction  in 
atonic  constipation  (330),  have  patient  stand  with 

48 


Exercises 

hands  on  hip  and  lean  backwards  and  forwards  alter- 
nately so  as  to  arch  the  lumbar  region  forward  as 
much  as  possible.  The  latter  maneuver  makes  trac- 
tion on  the  lumbar  nerves.  The  index  of  correct  exe- 
cution is  indicated  by  the  conversion  of  the  tympani- 
tic  intestinal  sound  into  dullness. 


Progressive     Spondylotherapy 


CHAPTER  III. 

THE    CIRCULATORY    APPARATUS 

INSPECTION  OF  PRECORDIUM — TESTING  HEART — ANGINA  PEC- 
TORIS  —  ENDOCARDITIS  —  TACHYCARDIA  —  BLOOD-PRESSURE — 
ANEURYSMS — VASOMOTOR  NEUROSES — EXOPHTHALMIC  GOITRE 

INSPECTION  OF  THE  PRECORDIUM.— Reference  has  al- 
ready been  made  on  page  14,  to  vago-visceral  methods 
and  particularly  to  vago-visceral  heart-palpation. 
If  the  identical  method  is  employed,  each  time  pres- 
sure is  made,  the  area  of  the  heart  may  be  defined. 
This,  like  other  shadows  is  accentuated  by  gamboge 
(page  14). 

The  vago-visceral  reflex  is  readily  exhausted,  there- 
fore if  not  properly  seen  after  pressure  is  made  sev- 
eral times,  one  must  wait  until  vagus-tone  is  restored. 
The  patient  while  seated  faces  the  window  and  the 
physician  views  the  precordium  from  above  down- 
ward. 

During  the  time  pressure  is  made,  the  chest  should 
be  in  the  position  of  forced  expiration  and  breathing 
suspended. 

The  outlines  of  the  right,  are  less  easily  demon- 
strable than  those  of  the  left  heart. 

After  a  little  experience,  the  shadow  is  easily  recog- 
nized even  in  moderately  obese  subjects.  The  same 
method  is  available  in  inspecting  aneurysms.  Here,  a 
bulge  in  lieu  of  the  shadow  is  often  seen.  Inspection 
must  be  from  above. 

TESTING  THE  EFFICIENCY  OF  THE  HEART. — Heart-suf- 
ficiency (215,  510),  is  a  neuro-muscular  question  and 
its  correct  estimation  demands  an  investigation  of 
vagus-tone  and  the  condition  of  the  myocardium. 

50 


Testing     the     Efficiency     of     the     Heart 

Vagus-tone  is  determined  by  the  method  described 
on  page  10. 

With  the  spondylopressor,  myocardial  tone  is  esti- 
mated by  the  intermittent  impact  of  the  heart  against 
the  palpating  finger  (page  15)  each  time  pressure 
is  executed  with  the  spondylopressor. 

Attention  has  been  directed  on  page  10,  to  an  im- 
portant clinico-physiologic  investigation  which  is 
available  in  visceral-toning. 

Physio-therapy  is  essentially  a  matter  of  eliciting 
reflexes  and  if  the  visceral  reflexes  are  ignored,  the 
scientific  value  of  the  treatment  in  most  instances  can 
not  be  guaged  and  the  results  must  be  empirical. 

Visceral  reflexes  may  be  evoked  in  many  ways  (7) 
therefore  there  are  many  ways  of  achieving  results. 

One  must  remember,  however,  that,  although  one 
afferent  channel  may  be  exhausted  by  overstimula- 
tion,  another  channel  may  be  solicited  to  provoke  like 
reflexes. 

Pituitrin,  is  a  most  efficient  agent  for  increasing 
vagus-tone. 

After  injecting  i.  c.  c.  of  the  preparation  of  Parke 
Davis,  the  following  average  result  was  noted : 

Recession  of  stomach 3     cm. 

"  heart  (left  border)  2.3  cm. 

"  liver  1.8  cm. 

Descent  of  lung-border 2.6  cm. 

Pituitrin  has  a  more  marked  action  on  the  heart 
than  pilocarpin  (454). 

The  heart  reflex  (199)  is  absent  in  the  presence  of 
pericardial  adhesions  and  apparently  so  in  pleural 
exudatcs.  A  few  months  ago,  I  was  attempting  to 
elicit  the  reflex  for  Prof.  Einthoven,  who  was  the  first 
to  employ  electrocardiagrams  which  show  electrical 

51 


Progressive     Spondylotherapy 

r~ 

variations  due  to  the  heart  contraction.  No  reflex  was 
obtainable.  It  was  subsequently  determined  that  the 
subject  had  just  recovered  from  pericarditis  with  ad- 
hesions. 

In  another  case  seen  in  consultation,  the  apparent 
absence  of  the  reflex  was  due  to  the  pleura!  fluid  fol- 
lowing the  recession  of  the  heart. 

ANGINA  PECTORIS. — Dr.  George  Jarvis,  has  directed 
my  attention  to  an  important  clinical  observation 
which  he  has  made,  viz.,  that  in  two  cases  of  angina 
pectoris  he  was  unable  to  elicit  the  heart  reflex  of  con- 
traction during  a  paroxysm.  This  observation  I  have 
since  confirmed.  These  observations  would  seem  to 
confirm  my  heart  reflex  theory  of  angina  (222). 

ENDOCARDITIS. — During  several  years  I  have  ob- 
served three  cases  of  chronic  endocarditis  which  were 
apparently  cured  by  injections  of  fibrolysin  (108) 
coupled  with  concussion  of  the  7th  cervical  spine  to 
elicit  the  heart  reflex  of  contraction.  The  latter  is 
practically  a  method  of  cardiac  gymnastics.  I  would 
not  have  reported  these  apparently  incredible  results 
were  it  not  for  the  fact  that  Dr.'  Jaworski,  in  a  per- 
sonal communication  reported  that  Dr.  Haffner  of 
Zurich  had  achieved  like  results  in  two  cases. 

TACHYCARDIA. — This  is  often  difficult  to  relieve  and 
the  physician  must  experiment  to  determine  which 
method  is  most  effective  in  influencing  the  chrono- 
tropic  fibers.  In  some  instances,  I  have  achieved  re- 
sults by  concussing  the  7th  cervical  spine,  striking  one 
blow  per  second.  In  other  instances,  I  have  directed 
stimulation  on  either  side  of  the  7th  cervical  spine  so 
as  to  influence  either  the  right  or  left  vagus  (page  75) 
Some  physicians  have  obtained  good  results  by  con- 
cussing the  6th  or  4th  cervical  spine. 

Dr.  E.  W.  Cox  (Monroe,  Washington),  reports  a 

52 


Blood 


s    s    u 


case  of  paroxysmal  tachycardia  requiring  morphin 
for  the  attacks  which  were  cured  by  concussion  of  the 
7th  cervical  spine. 

BLOOD  PRESSURE. — There  are  some  data  with  refer- 
ence to  this  subject  that  have  not  been  fully  empha- 
sized. 

In  the  employment  of  the  excellent "  Brown  Sphyg- 
momanometer"  (Fig.  11),  one  estimates  (to  get  ac- 
curate results),  the  diastolic  as  well  as  the  systolic 
pressure. 


FIG.  11. — The  Brown  sphygmomanometer.  The  mercury  cannot  be  lost 
and  the  cuff  is  12  cm.  in  width,  and  23  cm.  in  length. 

When  the  slightest  wave  is  felt  by  the  operator,  this 
is  the  systolic  and,  when  the  full,  normal  beat  of  the 
pulse  is  first  noted,  that  is  the  diastolic  pressure. 

The  auscultatory  method  is  more  accurate.  One 
places  a  stethoscope  over  the  radial  artery  just  below 
the  bend  of  the  elbow  and  allows  the  air  to  escape 
from  the  valve.  The  systolic  pressure  is  noted  the 
moment  a  thump  is  heard.  Allow  more  air  to  escape 
and  the  moment  the  thump  is  no  longer  heard,  we 

53 


Progressive     Spondylotherapy 

have  the  diastolic  pressure.  By  subtracting  the  dias- 
tolic  from  the  systolic  pressure,  the  remainder  is  the 
pulse  pressure. 

The  difference  between  the  systolic  and  diastolic 
pressure  in  the  norm  is  from  25  to  40  mm.  Among  the 
common  factors  influencing  the  readings  are : 

1.  Digestion,  for  3  hours  after  a  repast ; 

2.  Altitude  (increases)  ; 

3.  Exercise  (rise  of  20  to  40  mm.  which  resumes 
its  previous  level  in  about  15  minutes)  ; 

4.  Tobacco,  when  used  to  excess; 

5.  Pain  and  emotions  (augment  pressure). 

HIGH -BLOOD  PRESSURE  (Hypertension). — The  term 
hyperpiesis,  refers  to  simple  high  pressure  without 
any  evidence  of  cardio-vascular  disease. 

Hypertension  is  caused  by  a  multitude  of  diseases 
(234).  If  possible,  one  should  always  ascertain  the 
cause  including  emotional  factors,  intestinal  toxemia, 
anomalies  in  the  splanchnic  area  and  augmented  se- 
cretion of  pressor  products  by  the  adrenals. 

If  the  latter  condition  is  present,  there  must  be  a 
dilation  of  the  stomach  and  contraction  of  the  lungs 
(page  9).  We  also  determine  that,  if  by  increasing  the 
secretion  of  the  adrenals  (page  9),  we  still  further 
augment  blood-pressure. 

Conversely,  if  there  is  hypotension  (250),  stimu- 
lation of  the  phrenic  or  splanchnic  nerves  will  raise 
the  pressure.  Reduction  of  blood-pressure  is  best  ef- 
fected by  concussion,  pressure  or  other  methods  of 
stimulation  applied  between  the  3rd  and  4th  dorsal 
spines  (461). 

At  the  latter  point,  we  stimulate  the  depressor 
nerve  (468). 

If,  coincident  with  the  pressure  or  other  stimulus, 
percussion  of  the  lower  abdomen  is  executed,  areas 

54 


Aneurysms 

of  dullness  caused  by  dilatation  of  the  splanchnic  ves- 
sels may  be  elicited  (433). 

The  physiologist  knows  that  stimulation  of  any 
centripetal  nerve  augments  blood-pressure  and  the 
essential  factor  in  this  reflex  rise  is  vasoconstriction 
in  the  splanchnic  area. 

The  only  exception  to  the  foregoing  rule,  is  stimu- 
lation of  the  depressor  nerve,  which  lowers  pressure 
by  dilating  the  splanchnic  vessels. 

The  latter  have  the  greatest  effect  on  blood-pres- 
sure and  the  vessels  in  question  are  sufficiently  ca- 
pacious to  hold  practically  the  entire  blood- volume  of 
the  body. 

Another  fact  must  be  emphasized  in  the  diagnosis 
of  arteriosclerosis  by  palpation  of  peripheral  ar- 
teries. 

A  thickened  artery  is  not  necessarily  atheromatous 
but  is  often  caused  by  an  hypertrophy  of  the  muscu- 
lar coat  of  the  artery. 

ANEURYSMS. — In  a  discussion  following  an  address 
before  the  "Los  Angeles  County  Medical  Associa- 
tion, ' '  one  of  the  disputants  discussed  a  patient  with 
an  aneurysm  who  was  treated  according  to  telegraph- 
ic instructions  received  from  me.  He  hadn't  any 
faith  in  my  method,  he  argued,  for  the  reason  that  al- 
though the  method  was  employed  the  patient  died 
three  weeks  later.  I  replied  that  the  gentleman  evi- 
dently had  more  faith  in  the  methods  of  spondylo- 
therapy  than  I.  I  did  not  hope  to  resuscitate  the  dead 
and  if  the  patient  had  died  three  weeks  later,  he  was 
practically  moribund  when  treatment  was  com- 
menced. 

This  directs  our  attention  to  the  importance  of  an 
early  diagnosis  and  I  am  almost  inclined  to  believe 
that,  by  my  method  of  treatment  of  aneurysms 

55 


Progressive     Spondylotherapy 

Aneurysma  primis  in  stadiis  semper  curabilis. 
Aneurysms  are  by  no  means  infrequent  (551). 

Ever  since  Chiari5  and  Marchand6,  described  mes- 
aortitis  (552)  in  syphilitics,  much  evidence  has  accu- 
mulated notably,  the  statistics  of  Goldscheider7,  to 
justify  the  correctness  of  their  conclusions.  Among 
the  early  symptoms  of  syphilitic  aortitis  are ;  pains  of 
the  upper-chest  accentuated  by  exertion,  constriction 
of  the  chest,  palpitation,  modification  of  the  first 
aortic  sound  or  the  presence  of  systolic  and  diastolic 
murmurs  or,  in  the  absence  of  the  latter,  a  ringing 
second  sound. 

An  increased  area  of  dullness  over  the  aorta  is 
practically  constant  but  owing  to  its  late  detection,  it 
is  regarded  as  a  late  sign. 

An  important  sign,  is  the  intensification  or  repro- 
duction of  symptoms  by  elicitation  of  the  aortic  reflex 
of  dilatation  (256). 

Relief  by  energetic  antisyphilitic  treatment  (in- 
cluding salvarsan  or  neosalvarsan)  is  diagnostic.  The 
iodids  alone  have  little  action. 

Implication  of  the  aorta,  even  in  the  absence  of  a 
syphilitic  anamnesis  and  with  a  negative  Wasser- 
mann,  should  suggest  nevertheless,  a  syphilitic 
aortitis. 

Percussion,  is  unquestionably  the  most  important 
early  sign  of  a  dilated  aorta,  but  such  percussion 
must  conciliate  every  possible  aid  (558). 

Not  long  ago,  the  writer  saw  a  patient  in  consulta- 
tion with  several  skilled  diagnosticans.  The  case  was 
diagnosed  as  one  of  asthma.  No  increase  in  area  of 
the  aorta  was  noted  by  the  usual  method  of  percussion 
but  when  the  vago-visceral  method  of  percussion  was 
employed,  an  increased  area  of  dullness  was  demon- 
strable. It  was  shown  that,  by  artificial  dilation  of 
the  aorta  (256),  asthmatic  symptoms  could  be  evoked 

56 


Aneurysms 

and  at  once  relieved  by  artificial  contraction  of  the 
vessel. 

The  subjective  symptoms  of  a  dilated  aorta  are 
paroxysmal. 

Orthodiagraphic  tracings  made  by  myself  at  dif- 
ferent times  during  the  day  have  convinced  me  that 
the  aorta  is  not  constant  in  caliber  and  one  can  under- 
stand why  a  temporary  increase  of  aortic  dilatation 
may  precipitate  a  medley  of  symptoms  which 
disappear  when  the  lumen  of  the  vessel  is  restored. 

The  foregoing  is  equally  true  of  the  heart.  Recent- 
ly, in  Philadelphia,  I  saw  a  patient  with  Dr.  S.  Solis 
Cohen.  The  patient  had  cardiac  asthma  and  it  was 
possible  to  provoke  or  inhibit  the  symptoms  at  will 
by  decreasing  or  increasing  vagus-tone. 

Attention  is  directed  to  the  X-ray  pictures  of  Dr. 
Jarvis  (Fig.2),  showing  the  accuracy  of  vago- visceral 
percussion. 

I  want  to  call  attention  to  certain  errors  of  inter- 
pretation which  may  attend  aortic-percussion. 

In  splanchnoptosis,  ptosis  of  the  heart  (529)  is 
often  a  concomitant  condition  which  conduces  to  a 
dislocation  of  the  thoracic  aorta  (aorto ptosis).  Per- 
cussion shows  an  extension  of  dullness  beyond  the 
norm  and  fluoroscopy  demonstrates  an  extended  sil- 
houette of  the  aorta. 

Unlike  an  aneurysm,  the  shadow  between  pulsa- 
tions recedes  behind  the  sternum. 

A  pathogiiomonic  test  is  to  have  an  assistant  raise 
the  abdomen,  at  which  time  percussion  and  fluoro- 
scopy show  a  recession  of  the  dullness  and  shadow. 

The  shadow  of  an  inthrathoracic  goitre  may  be  mis- 
interpreted as  an  aneurysm.  This  is  likely  if  an  adja- 
cent blood-vessel  notably  the  aorta  communicates  pul- 
sations. In  examinations  with  the  fluoroscope  one 
must  remember  that  the  thyroid  shows  an  up-and- 

57 


Progressive     Spondylotherapy 

down  movement  synchronous  with  deglutition  and 
the  respitory  phases  whereas  the  shadow  of  the  aorta 
is  immobile. 

Before  deciding  that  a  dullness  of  the  abdominal 
aorta  responding  to  the  aortic  reflexes  (262)  is  caused 
by  aneurysm,  have  the  colon  thoroughly  cleaned.  It 
has  been  found  that,  the  descending  colon  will  re- 
spond in  a  like  manner  to  these  reflexes  and  the  pres- 
ence of  fecal  matter  may  lead  to  an  error  in  diagnosis. 

Disregarding  the  latter  fact,  I  have  made  the  egre- 
gious mistake  in  two  instances  of  diagnosing  an  an- 
eurysm of  the  abdominal  aorta.  The  diagnosis  of  an- 
eurysms  of  the  thoracic  aorta  by  inspection  is  facili- 
tated by  the  vago- visceral  method  (page  50). 

By  aid  of  surgery  we  may  anticipate  much  respect- 
ing the  treatment  of  aneurysms.  There  is  the  ingeni- 
ous operation  of  aneurysmorrhaphy  of  Matas,  and 
the  wonderful  work  of  Carrel,  which  leads  us  to  anti- 
cipate the  substitution  of  a  " cold-storage"  healthy 
vessel  for  the  resected  diseased  portion  of  the  vessel. 

There  is  practically  nothing  that  I  can  add  to  my 
method  of  treating  aneurysms  (257,  568)  which  em- 
braces aneurysms  of  the  innominate,  carotid  and 
thoracic  and  abdominal  aorta. 

Reference  however  to  page  68,  shows  that  the  meth- 
od of  executing  the  treatment  will  influence  results. 
Concussion  and  not  vibration  must  be  used.  An  effi- 
cient concussor  recently  perfected  is  shown  in  Fig.  12. 

Dr.  C.  B.  Kolhousen,  of  New  Mexico,  has  sent  me 
a  report  of  an  advanced  case  of  aneurysm  of  the  thor- 
acic aorta  treated  by  my  method  of  concussion. 

He  says,  "After  the  first  treatment  lasting  10  min- 
utes, I  was  utterly  amazed  at  the  change  of  the  condi- 
tion of  the  patient  and  after  six  days  all  his  symp- 
toms had  disappeared  and  he  was  symptamatically 
well." 

58 


FIG.  12. — Dr.  Abrams'  concussor. 

One  of  the  important  advantages  possessed  by  this  apparatus  is  the 
pair  of  rubber  grips  which  are  placed  vertically  on  the  vertebra  and 
which  confine  the  application  to  the  exact  spot  indicated,  preventing 
slippage  of  the  concussor-applicator  with  consequent  abrasions  of  the  skin. 

The  Sliding  Sleeve  surrounding  the  concussor  shaft  serves  as  a  con- 
venient handle  to  guide  the  application.  This  sleeve  may  be  adjusted  up- 
wards or  downwards  by  means  of  a  set  screw,  thus  regulating  the  dura- 
tion of  contact  of  each  concussive-stroke.  By  adjusting  the  distance  of 
the  eccentric  at  end  of  transmission-shaft  the  stroke  may  be  varied  from 
zero  to  one  inch. 

By  a  unique  method  of  speed  control  consisting  of  a  pair  of  inverted 
cones  with  a  sliding  belt,  held  taut  by  an  idler-pulley  with  spring  auto- 
matically taking  up  the  slack,  the  frequency  of  stroke  may  be  varied  from 
600  to  3600  per  minute.  The  change  of  speed  is  effected  by  turning  the 
milled  set-screw  so  that  the  idler-pulley  is  drawn  forward,  giving  a  low 
speed;  or  backward,  giving  a  high  speed. 

The  motor  is  of  ample  power  to  produce  concussion  capable  of  eliciting 
every  reflex  of  the  spine  and  for  giving  prolonged  treatment  without  heat- 
ng  or  over  straining  in  the  least.  The  motor  is  suspended  from  a  bracket 
by  cord  and  pulleys  with  counterweight,  enabling  the  operator  by  the  han- 
dle to  swing  the  concussor  back  and  forth  from  the  cervical  spine  to  the 
sacrum  with  perfect  ease  and  facility  of  application.  The  bracket  can  be 
attached  easily  to  a  door-jamb,  window  frame  or  can  be  firmly  anchored 
to  a  studding  or  a  plastered  wall  or  by  suitable  attachments  to  tile-wall. 

For  the  operator  who  has  no  available  wall  space  two  pulleys  can  be 
furnished  whereby  the  concussor  can  be  suspended  from  the  ceiling. 

For  those  who  desire  an  apparatus  which  can  be  moved  about  from 
one  room  to  another,  the  entire  apparatus  including  bracket  can  be 
mounted  upon  a  substantial  pillar  and  tripod  with  casters  which  can  be 
readily  rolled  about. 


59 


Progressive     Sp  on  dylo  therapy 

When  in  1911, 1  reported  in  "The  British  Medical 
Journal"  and  in  "La  Presse  Medicale,"  40  cases  in 
my  own  practice  of  thoracic  and  abdominal  aneurysm 
symptomatically  cured  within  a  few  weeks  by  the 
concussion-treatment  with  absolutely  no  other  ad- 
juvant measure,  not  even  rest,  there  was  no  break  in 
the  continuity  of  results.  The  cases  were  all  advanced. 
Up  to  that  time  other  physicians  have  reported  in  the 
journals  and  through  correspondence  equally  good 
results.  Since  then  several  cases  have  come  under 
my  observation  in  which  the  results  were  modified 
by  complications. 

One,  referred  to  me  by  Dr.  Minaker,  died  from 
parenchymatous  nephritis  which  existed  at  the  time 
of  consultation,  although  up  to  the  time  of  her  death, 
the  aneurysmal  symptoms  did  not  recur. 

The  same  was  observed  in  a  patient  referred  to  me 
by  Dr.  Voorsanger,  who,  at  the  time  of  consultation 
had  tuberculosis. 

In  a  case  reported  by  Dr.  L.  St.  John  Hely  (571), 
treated  for  about  10  days,  he  wrote  me  18  months  lat- 
er, that  it  was  indeed  marvelous  that  after  this  period 
of  time,  the  once  moribund  patient  was  without  a  sin- 
gle symptom.  One  week  later,  he  informed  me  that 
the  patient  had  suddenly  died  from  rupture  of  the 
aneurysm  while  lifting  a  heavy  trunk. 

Prompted  by  my  early  results,  I  believed  that  a 
symptomatic  cure  of  aneurysms  could  be  achieved  in 
about  two  weeks. 

Time  however  has  discredited  this  outburst  of  en- 
thusiasm. 

Several  months  ago  there  came  to  my  office  a  pa- 
tient with  an  immense  aneurysm  (Fig.  13).  He  had 
been  treated  by  Dr.  Chas.  E.  Atkinson,  of  Los  Ange- 
les, who  had  employed  my  method.  No  results  were 
achieved  for  one  month,  after  which  time,  the  patient 

60 


Aneurysms 

resumed  his  occupation.  Dr.  Atkinson  had  enjoined 
him  to  take  the  usual  precautions  but  without  avail, 
for  later,  in  lifting  a  heavy  automobile,  the  aneurys- 
mal  symptoms  recurred. 


FIG.  13. — Patient  of  Dr.  Atkinson  with  an  aneurysm  of  the  thoracic  aorta. 

When  I  saw  the  patient,  he  was  using  morphin  (/4 
grain,  hypodermatically,  three  times  a  day).  After  the 
first  treatment  by  concussion,  he  discontinued  the 
drug  of  his  own  accord  as  he  no  longer  suffered  from 
pains. 

About  two  months  later,  Dr.  Atkinson,  informed 
me  of  the  death  of  the  patient.  At  the  necropsy,  the 
ascending  portion  of  the  aortic  arch  was  6  inches  in 
diameter  and  the  rest  of  the  aorta  was  very  much 
dilated. 

Still  another  case  demands  citation. 

Dr.  A.  C.  Ackerman,  of  La  Fayette,  Indiana,  re- 
quested me  to  see  with  him  in  consultation  a  patient 
with  an  aneurysm  whom  he  said,  was  practically  mor- 

61 


Progressive     Spondylotherapy 

ibund.  This  patient  was  treated  by  Dr.  Ackermaii, 
for  3  weeks  without  any  result. 

The  case  was  nevertheless  interesting  and  empha- 
sized a  very  pertinent  fact.  It  was  impossible  to  cor- 
rectly locate  the  7th  cervical  spinous  process  owing 
to  a  spinal  deformity.  Its  location  was  effected  after 
his  manner ;  after  percussing  the  area  of  dullness  of 
an  enormous  aneurysm,  different  spinous  processes 
were  successively  concussed  until  one  was  found 
which  produced  a  decided  reduction  in  the  area  of 
dullness  (aortic  reflex  of  contraction).  The  latter  was 
marked  and  concussion  executed  at  this  point. 

The  same  method  of  procedure  is  indicated  in  the 
treatment  of  other  affections.  -There  may  be  some 
anomaly  even  in  segmental  localization. 

Thus,  in  asthma,  if  pressure  between  the  3rd  and 
4th  dorsal  spines  does  not  cause  an  evanescence  of  the 
rales,  make  pressure  at  other  points  until  one  is  found 
which  yields  results. 

There  is  yet  another  matter  demanding  citation 
which  may  account  for  some  of  my  results  in  aneur- 
ysm. 

A  limited  number  of  observations  show  that,  con- 
cussion of  the  7th  cervical  spine  appears  to  increase 
the  coagulability  of  the  blood. 

The  effect  of  concussion  at  this  point  on  the  num- 
ber of  erythrocytes  has  already  been  established 
(617). 

VASOMOTOR  NEUROSES:  (275  et  seq.}. — The  vasomo- 
tor  mechanism  is  deserving  of  brief  consideration. 
Vasomotility  is  under  the  direct  influence  of  the  sym- 
pathetic system.  The  vasoconstrictor  fibers  arise  from 
the  sympathetic  chain  of  ganglia  and  the  vasodilator 
fibers  from  the  collateral  ganglion  system. 

62 


Vasomotor       Neurose 


FIG.  14. — Mechanism  of  vasomotility  (after  Bing).  A,  cerebro-bulbar 
vaso motor  tract;  B,  bulbo-spinal  vasomotor  tract;  C,  spino-sympathetic 
vasomotor  tract;  D,  sympathetico-muscular  vasomotor  tract;  G.  R.  C.  and 
W.  R.  C.,  gray  and  white  ramt  communicantcs;  S.  G.,  sympathetic  and 
ganglion  of  spinal  nerve.  Sym.  C.,  sympathetic  chain;  A.  R.,  anterior  root 
of  spinal  nerve. 

63 


Progressive     Spondylotherapy 

The  vasoconstrictors  are  found  in  the  mixed  spinal 
nerves  which  they  reach  by  the  grey  rami  communi- 
cantes. 

The  spinal-centers  for  vasoconstriction  lie  in  the 
ventral  horns  and  pass  from  the  cord  through  the  an- 
terior roots  along  the  white  rami  communicant es  to 
the  sympathetic  chain. 

The  spinal  vasomotor  centers  are  governed  by  a 
bulbar  and  a  cerebral  center.  The  implication  of  the 
latter  is  noted  when  blushing  or  pallor  follows  psy- 
chic emotions. 

Fig.  14,  reproduces  schematically  the  mechanism  of 
vasomotility  with  the  following  neurones;  cerebro- 
bulbar,  bulbo-spinal,  spino-sympathetic  and  sympa- 
thetico-muscular. 

Vasodilator  fibers  exist  only  in  special  nerve- 
trunks,  e.  g.,  nervi  erigentes  and  the  sciatic.  Their 
clinical  significance  is  not  established.  It  is  assumed 
that  loss  of  vascular  tone  is  caused  by  paralysis  of  the 
vasoconstrictors  and  an  increase  of  vascular  tone  to 
a  stimulation  of  the  vasoconstrictors. 

By  some,  the  mechanism  of  perspiration  is  conceiv- 
ed to  be  similar  to  that  of  vasomotility  and,  if  one  sub- 
stitutes a  sweat-gland  for  the  blood-vessel  (Fig.  14), 
the  mechanism  of  perspiration  may  be  understood. 
The  cells  for  the  spinal  sweat-centers  are  located  in 
the  ventral  horns  in  proximity  to  the  motor  ganglion- 
cells  and  if  destroyed,  perspiration  is  diminished 
(hyphidrosis)  or  abolished  (anidrosis). 

The  diagnosis  of  cutaneous  vasomotor  neuroses  is 
not  difficult. 

The  difficulty  only  arises  in  the  visceral  angioneu- 
roses  and  the  latter  may  be  thought  of  in  the  presence 
of  bizarre  symptoms  in  individuals  with  the  vasomo- 
tor temperament  (424).  By  aid  of  spondylotherapeu- 
tic  methods  which  enable  us  to  contract  or  dilate 

64 


Vasomotor       Neuroses 


blood-vessels,  the  pathology  of  some  neuroses  should 
be  solved. 

Thus,  in  epilepsy,  the  paroxysmal  unconsciousness 
is  supposed  to  be  associated  with  sudden  cerebral 
anemia,  the  tonic  stage  of  a  major  epileptic  fit,  with 
cortical  anemia  and  the  clonic  stage,  with  return  of 
irterial  circulation. 

Some  physicians  have  informed  the  writer  that 
ihey  have  successfully  treated  epilepsy  by  my  method 
of  mechano-vaso-dilation. 


An£ Spinal  Artery 

ErancTvtOj 


br 

Intercostal, 

ArUry. 


branches  from/ 
Intercostal  Artery, 
'-' — 'fissure 


SpinuLArtxry 


— fosterutr 
jpinalArtery- 


FIG.  15. — Illustrating  the  course  and  distribution  of  the  terminal 
arteries  of  the  spinal  cord  (after  Gehuchten). 

Blood-vessels,  notably  arteriosclerotic  vessels  re- 
spond to  all  reflex  influences.  Thus,  in  cerebral  arter- 
iosclerosis, spasm  of  the  vessels  may  lead  to  transient 
attacks  of  vertigo,  aphasia,  monoplegia  or  hemiple- 
gia.  In  the  intermittent  limp  or  dysbasia  angioscler- 
otica,  a  cramp-like  pain  appears  when  the  individual 

65 


Progressive     Spondylotherapy 

attempts  to  walk.  In  such  cases,  the  skin  of  the  low- 
er extremity  is  cold  and  purple  or  mottled  red  and 
no  pulse  is  felt  in  the  posterior  tibial  or  the  dorsalis 
pedis  artery  (225). 

Such  phenomena  are  due  to  a  temporary  spasm  of 
the  arteries  of  the  lower  extremity.  They  have  also 
been  observed  in  the  upper  extremity. 

In  the  so-called  cases  of  family  gangrene  which  re- 
semble Raynaud's  disease  and  in  the  family  periodic 
paralysis,  there  is  probably  a  paroxysmal  vasomotor 
spasm  of  the  anterior  spinal  artery  which  supplies 
the  anterior  cornua  of  the  spinal  cord  (Fig.  15.) 

The  pains  and  visceral  crises  in  tabes  are  in  my 
opinion  often  caused  by  a  temporary  spasm  of  the 
spinal  vessels,  a  sort  of  an  intermittent  claudication 
of  the  spinal  cord. 

In  the  diagnosis  of  these  spasmodic  angioneuroses, 
I  make  constant  use  of  amyl  nitrite  and  a  rubber 
bandage.  The  former  is  employed  by  inhalation.  Its 
action  (flushing  of  face  and  cutaneous  blood-vessels 
including  veins)  is  manifested  within  15  seconds  and 
symptoms  disappear  within  3  minutes. 

.Any  phenomena  associated  with  angiospasm  yield, 
at  least  temporarily  to  the  action  of  amyl  nitrite. 
Conversely,  symptoms  (headache,  neuralgia)  caused 
by  hyperemia  are  accentuated. 

HYPEREMIA  TEST. — If  an  extremity  is  rendered 
anemic  by*  a  rubber  bandage  for  about  5  minutes  and 
after  its  removal  the  hyperemia  is  observed,  it  will  be 
found  that  in  the  norm,  the  latter  reaches  the  toes  or 
fingers  within  a  few  seconds. 

In  arteriosclerosis  however,  the  return  of  blood 
may  require  several  minutes  or  if  the  vessels  are  di- 
minished in  caliber  or  the  capillaries  are  obstructed, 
the  hyperemia  is  arrested  at  a  definite  point. 

66 


Vasomotor       Neuroses 

This  same  method  may  be  employed  in  a  modified 
way  for  treatment. 

Thus,  in  Raynaud's  disease  a  tourniquet  is  applied 
around  the  extremity  above  to  occlude  all  the  vessels 
for  several  minutes.  After  removal,  the  temporary 
vasomotor  paralysis  causes  a  diffused  flushing. 

If,  after  the  foregoing  method,  the  symptoms  are 
relieved,  or  if  a  pulse  previously  impalpable  becomes 
palpable,  the  character  of  the  lesion  is  probably  a 
vascular  spasm. 

Contractures  of  muscles  may  be  caused  by  short- 
ening or  distortion  (passive  or  permanent  contract- 
ures)  or  they  may  be  spasmodic  (temporary  or  ac- 
tive contractures). 

If  the  contracture  implicates  an  extremity,  the 
application  of  a  rubber  bandage  (not  exceeding  20 
minutes)  will  like  narcosis,  cause  active  contract- 
ures to  disappear  but  the  bandage  is  without  in- 
fluence on  the  passive  contractures. 

All  active  contractures  yield  temporarily  to  the 
application  of  the  bandage  hence  hysterical  cannot 
be  distinguished  from  non-hysterical  contractures. 
Junod's  blood  derivations  and  Bier's  hyperemic 
method  (hemospasia)  are  likewise  available  in  the 
diagnosis  and  treatment  of  angioneuroses. 

Vasoconstriction  of  the  blood-vessels  is  best  attain- 
ed by  concussion  or  the  use  of  the  rapid  sinusoidal 
current  applied  at  the  7th  cervical  spine  and  vasodila- 
tion,  by  concussion  or  slow  sinusoidal  current  to  the 
last  four  dorsal  vertebrae  (279). 

In  the  latter  maneuver,  the  maximum  effect  is  se- 
cured at  the  10th  dorsal  spine  (604). 

Vasoconstrictor  or  vasodilator  effects  may  be  ac- 
centuated by  recalling  an  established  physiologic  ob- 
servation. If  a  nerve  containing  vasoconstrictor  and 
vasodilator  fibers  is  stimulated  with  frequently  re- 
peated induced' currents,  the  constrictor  effect  is  the 

67 


Progressive     Sp on dy 1 o th er apy 

more  pronounced  but  if  stimulation  is  effected  with 
slowly  repeated  induced  currents,  the  dilator  effect 
is  the  more  pronounced. 

In  practice,  when  one  desires  the  maximum  vaso- 
constrictor action  (as  in  aneurysms),  only  rapid  con- 
cussion-blows must  be  used  whereas  vasodilator  ef- 
fects are  secured  when  the  blows  are  delivered  at  a 
rate  of  stimulation  of  one  per  second. 


FIG.   16. — Plethysmc 'graph  of  Hallion  and  Comte,  with  tracing. 

To  effect  the  latter  result,  the  plexor  and  pleximet- 
er  may  be  used  in  lieu  of  a  concussion-apparatus  and 
time  may  be  measured  by  a  metronome. 

The  action  of  the  sinusoidal  current  on  visceral 
muscle  has  been  discussed  on  page  7. 

By  reinforcing  the  reflexes  (page  40),  further  aid 
in  treatment  is  achieved.  Let  us  assume  a  case  of 
Raynaud's  disease.  Concussion  or  sinusoidalization 
of  the  10th  dorsal  spine  is  ineffective  in  restoring  an 
impalpable  pulse  of  the  leg.  An  attempt  is  then  made 
to  put  out  of  temporary  commission  the  subsidiary 
vasoconstrictor  center  (at  the  7th  cervical  spine) 
when  concussion  is  again  executed  at  the  10th  dorsal 
spine. 

By  employing  a  simple  plethysmograph  (Fig.  16) 

68 


Vasomotor       Neuro.  ses 

and  connecting  it  with  the  finger  or  toe  according  to 
whether  the  angioneurosis  is  located  in  the  upper  or 
lower  extremity,  one  may  ascertain  by  the  amplitude 
of  the  registered  curves,  tfye  most  available  spine  and 
the  best  stimulus  for  augmenting  the  circulation. 
Thus,  in  some  instances,  the  author  has  found  that 
concussion  (2  blows  a  second)  between  the  3rd  and 
4th  dorsal  spines  is  very  effective  in  dilating  the 
peripheral  vessels. 


FIG.    17. — Capillary    Dynamomometer. 

The  author  frequently  employs  a  sphygmomano- 
meter  in  lieu  of  a  plethysmograph  for  the  same  pur- 
pose the  object  being  to  ascertain  the  diastolic  pres- 
sure which  represents  the  maximum  pressure  of  the 
arterial- wall.  The  auscultatory  method  (page  53)  is 
available  for  this  object.  The  best  site  is  determined 
by  noting  the  maximum  diastolic  pressure  after  stim- 
ulation. 

Still  another  method  is  occasionally  employed  by 
the  author  in  intermittent  claudication  to  secure  vas- 
odilator effects  and  that  is,  interrupted  concussion 
blows  on  the  sciatic  nerve. 

An  excellent  method  for  demonstrating  the  capil- 
lary circulation  is  the  capillary  dynamometer  (Fig. 
17).  The  padded  button  is  placed  on  the  skin  at  a 
constant  pressure  for  a  definite  time  (usually  3  sec- 
onds). After  removing  pressure  determine  the  time 
it  takes  in  half-seconds  for  the  blood  and  color  to 
return — capillary  reflux  or  C.  R. 

Time  of  pressure  and  return  of  color  should  be 
measured  by  a  metronome  beating  half-seconds. 

69 


Progressive     Sp  ondy  1  o  th  er  apy 

ORIFICIAL  METHODS. — In  therapeutics,  there  are  no 
exclusive  methods  of  achieving  results.  This  fact  I 
have  emphasized  repeatedly. 

When  my  friend  Dr.  Jaworski,  of  Paris,  secures 
benefit  to  his  tabetics  by  urethral  dilatation  (639)  he 
does  so  by  promoting  reflex  vasodilation. 

When  Dr.  E.  H.  Pratt,  of  Chicago,  dilates  the  rec- 
tum he  effects  the  same  object  (638). 

The  remarkable  results  achieved  by  Dr.  Pratt,  in 
his  rectal  work  appeals  to  the  writer  with  special  ref- 
erence to  vasodilation. 

Dr.  Pratt,  has  shown  that  dilatation  of  the  sphinc- 
ters, especially  the  rectum,  exerts  a  powerful  stimu- 
lating effect  notably  on  the  circulation. 

This  stimulating  effect  on  the  capillaries  he  desig- 
nates as  "flushing  of  the  capillaries/' 

Anal  dilatation  flushes  the  capillaries  universally, 
equalizing  the  circulation  and  relieving  local  conges- 
tions. 

By  careful  dilatation  of  the  internal  sphincter  to 
the  point  of  suspending  respiration  and  then  releas- 
ing the  sphincter,  respiration  begins  and  continues 
and  must  be  regarded  as  one  of  the  most  potential 
means  for  resuscitation  from  collapse  caused  by  an 
anesthetic,  loss  of  blood  or  surgical  shock. 

Long  continued  dilatation,  has  on  the  contrary  a 
pernicious  effect.  I  have  carefully  controlled  the  ef- 
fects of  anal  dilatation  by  plethysmographic  and 
stethometric  tracings  and  can  corroborate  the  obser- 
vations of  Dr.  Pratt.  It  is  difficult  by  these  methods 
to  exclude  the  action  on  the  coccygeal  ganglion.  When 
the  latter  is  stimulated  by  the  finger  per  rectum,  there 
is  often  lightning  pains  through  the  abdomen,  a  de- 
sire to  defecate,  fullness  in  the  head  and  occasionally 
flushing  of  the  face. 

70 


Exophthalmic     Goitre 

EXOPHTHALMIC  GOITRE. — The  author's  treatment  of 
this  disease  has  already  been  discussed  (280,482). 

The  study  of  the  internal  secretions  constitutes  one 
of  the  most  important  epochs  in  revolutionary  and 
evolutionary  medicine. 

The  glands  of  internal  secretion  not  only  detoxi- 
cate  certain  products  of  metabolism,  but  furnish 
hormones  which  stimulate  anabolic  and  catabolic  pro- 
cesses and  furnish  tone  to  the  autonomic  and  sympa- 
thetic systems. 

In  1859  Schiff,  noted  fatal  results  in  dogs  after 
thyroidectomy,  and  a  cachexia  strumipriva  was  ob- 
served by  Kocher,  after  the  same  operations  in  hu- 
mans. 

Gull  and  Ord,  demonstrated  the  relation  of  the 
thyroid  gland  to  myxedema,  and  Murray,  showed  that 
the  latter  and  cretinism  yield  to  thyroid  feeding.  Oth- 
ers noted  the  relief  of  symptoms  in  thyroidectomized 
animals  following  subcutaneous  transplantation  of 
the  gland. 

Symptoms,  notably  tetany,  following  thyroidect- 
omy are  due  to  injury  or  removal  of  the  parathyroid 
glands  (two  small  pairs  of  glands  situated  behind  the 
lateral  lobes  of  the  thyroids  in  juxtaposition  to  the 
trachea.)  The  parathyroids  are  supposed  to  regulate 
calcium  metabolism  (page  45). 

Revivescency  of  the  thymus  gland  has  been  noted  in 
exophthalmic  goitre,  and  implantation  of  this  gland 
in  dogs  has  been  followed  by  tachycardia  and  exoph- 
fhalmos.  Exophthalmic  goitre  is  probably  caused  by 
hyptonia  of  the  vagus. 

The  symptoms  are  supposedly  caused  by  a  hyper- 
secretion  of  the  thyroid  gland  conducing  to  a  species 
of  chronic  intoxication  (thyrotoxicosis).  The  enlarg- 
ed glands  show  increased  vascularity  and  secreting 
epithelium.  There  is  practically  always  some  hyper- 

71 


Progressive     Sp  on  dy  1  o  th  e  r  a  p  y 

plasia  of  the  gland.  The  anatomic  changes  are  not 
pathognomonic.  The  symptom-complex  of  the  dis- 
ease is  associated  with  conditions  of  the  gland  rang- 
ing from  the  norm  to  hyperplasia,  atrophy  and  the 
presence  of  benign  and  malignant  growths. 

The  thyroid  provokes  symptoms  from  deficiency  or 
excess  of  its  internal  secretion  or  from  irregular 
functional  activity  (dysthyroidism) . 

The  most  important  principle  isolated  from  the 
gland  is  iodothyrin.  The  iodin  in  the  gland  was  first 
demonstrated  by  Bauniann  in  1896.  Iodin  is  prac- 
tically absent  in  other  tissues,  and  its  amount  in  the 
thyroid  varies  with  the  species  and  the  individual. 

Vegetables  contain  iodin  and  it  is  therefore  most 
abundant  in  herbivora  and  least  in  amount  in  car- 
nivora. 

The  iodin  content  is  increased  by  the  administra- 
tion of  potassium  iodid,  and  decreased  by  a  diet  of 
meat. 

lodoform  poisoning  suggests  thyroid  intoxication 
and  in  animals  dosed  with  iodoform,  the  iodin  con- 
tent of  the  thyroid  is  augmented. 

In  all  goitres,  excepting  exophthalmic  goitre,  the 
quantity  of  iodin  in  the  gland  is  reduced. 

Good  and  bad  results  have  been  reported  from  the 
use  of  iodin  in  this  disease.  Kocher,  found  in  a  series 
of  160  thyroid  examinations  in  those  known  to  have 
received  iodin  that  there  was  a  definite  storage  in  the 
gland  which  was  associated  with  an  involution  of  tlie 
hyperplasia. 

The  normal  thyroid  contains  arsenic  and  thyroid 
ism  may  be  prevented  or  alleviated  by  the  concurred 
use  of  Fowler's  solution  (3  minims,  three  times  a 
day). 

Hyperthyroidism  is  not  always  expressed  by  a 
typic  symptomatic  picture  and  a  persisent  tachy- 

72 


Exophthalmic     Goitre 

cardia  may  be  the  only  evidence  of  augmented  activ- 
ity of  the  gland. 

In  other  instances,  the  frontier  symptoms  may  be 
emaciation,  amenorrhea,  irritability,  or  some  mental 
anomaly. 

Kolb,  in  a  recent  communication  maintains  that,  in 
diarrhea  without  a  palpable  cause,  one  should  always 
think  of  a  masked  incipient  exophthalmic  goitre. 
Cases  of  acute  hyperthyroidism  are  characterized  by 
rapid  emaciation,  pyrexia,  and  spleen-enlargement 
and  tachycardia.  The  thyroid  gland  may  not  be 
enlarged  but  auscultation  of  the  gland  shows  nearly 
always  the  presence  of  arterial-murmurs. 

Uterine  myomata  may  provoke  cardiac  symptoms 
suggestive  of  hyperthyroidism. 

To  facilitate  exploration  of  the  thyroid  the  method 
of  Woodbury  is  to  be  adopted;  the  neck  is  extended 
and  the  chin  rotated  nearly  over  to  the  opposite  shoul- 
der, with  the  side  of  the  head  slightly  flexed  on  the 
chest. 

Search  must  also  be  made  for  aberrant  and  acces- 
sory thyroids,  notably  at  the  root  of  the  tongue.  This 
lingual  thyroid  is  not  uncommon. 

To  estimate  the  degree  of  struma  and  exophthal- 
iios,  I  make  tracings  on  a  piece  of  ground  glass  which 
is  approximated  to  the  neck  and  head  in  a  dark  room 
with  light  at  a  fixed  point  and  properly  adjusted. 

One  may  make  an  immediate  diagnosis  of  hyper- 
thyroidism by  bearing  in  mind  the  fact  that,  increas- 
ing the  tone  of  the  vagus  will  ameliorate,  whereas  a 
decrease  of  the  tone  of  the  latter  will  accentuate  the 
symptoms. 

For  this  purpose  the  radicularpressor  (468)  is 
used.  Brief  pressure  (not  exceeding  30  seconds)  at 
the  7th  cervical  spine  increases  and  between  the  3rd 

73 


Progressive     Spondylotherapy 

and  4th  dorsal  spines  decreases  vagus-tone.  This 
barodiagnostic  maneuver  is  illustrated  in  fig.  18. 

All  human  emotions  may  be  expressed  through  the 
vagus.  The  tone  of  the  entire  nerve  may  be  compro- 
mised but  the  brunt  of  increased  or  diminished  tone 
may  be  borne  by  an  individual  branch  (452).  For 
this  reason  we  can  understand  why  certain  visceral 
symptoms  predominate.  The  great  physicist  Clerk- 
Maxwell  was  sponsor  for  the  truism  that,  progress 
was  symbolized  in  the  clock,  the  balance  and  the  foot- 
rule  thereby  implying  if  we  could  weigh,  measure  and 
time,  we  could  offer  facts  in  lieu  of  theories. 

By  aid  of  the  spondylopressor  (page  11),  we  can 
gauge  objectively  with  almost  mathematic  certainty 
the  degree  of  tone  of  a  given  viscus  receiving  vagal- 
innervation.  When  pressure  is  executed  at  the  7th 
cervical  spine  the  pulse  may  be  inhibited.  The  more 


ABC 

FIG.  18. — Eyes,  illustrating1  the  effects  on  the  exophthalmos  in  exoph- 
thalmic goitre,  by  increasing  and  diminishing  vagus-tone;  A,  before;  B, 
during  time  vagus-tone  is  diminished;  and  C,  when  vagus-tone  is  in- 
creased. (Compare  by  looking  at  depression  in  bridge  of  nose,  caused 
from  the  wearing  of  eyeglasses.) 

the  tone  of  the  vagus  is  diminished  (referring  to  the 
cardiac  branches)  the  weaker  is  the  stimulus  neces- 
sary to  elicit  cardiac  inhibition. 

Thus  we  can  recognize  an  orthotonic,  hypertonic, 
hypotonic  or  even  an  atonic  vagus. 

In  the  norm,  in  orthotonia  of  the  vagus,  cardiac 
inhibition  does  not  occur  when  the  pressure  exerted 
is  less  than  10  kilograms.  I  have  found  that,  in 

74' 


Exophthalmic     Goitre 

exophthalmic  goitre  (notably,  when  cardiac  symp- 
toms prevail)  that  the  pulse  may  be  inhibited  at  very 
low  pressure  (2  to  8  kilograms)  and  with  improve- 
ment more  and  more  pressure  is  necessary  to  inhibit 
the  pulse. 

This  clinical  fact  is  in  accord  with  physiologic 
observations.  If  a  frog's  heart  is  connected  with  a 
heart-lever  by  the  suspension  method  and  a  1  per 
cent,  solution  of  Merck's  thyro-iodin  is  dropped 
upon  the  heart,  and  one  determines  the  threshold 
at  which  the  minimal  stimulus  is  effective  in  slowing 
the  heart,  it  will  be  found  that  less  intensity  of 
current  is  necessary  to  produce  slowing. 

Hyperthyroidism  then ,  like  thyro-iodin  in  the 
experiment,  augments  the  sensitiveness  of  the  ter- 
minal end-apparatus  of  the  vagus. 

Experiments  on  dogs  show  that  there  is  a  qualita- 
tive difference  in  the  action  of  the  two  vagi.  Thus, 
stimulation  of  the  right  vagus  causes  arrest  of  the 
chambers  of  the  heart  whereas  stimulation  of  the  left 
vagus  has  a  slight  negative  chronotropic  action  on  the 
auricles.  With  the  spondylopressor  using  the  small 
attachment  (Fig.  1),  a  difference  will  be  noted  in  the 
pulse  even  in  the  norm  according  to  whether  pressure 
is  made  on  the  right  or  the  left  side  of  the  7th  cervical 
spine. 

It  is  often  possible  to  get  chronotropic  effects  in 
tachycardia  on  one  side.  I  have  also  observed  the 
curious  fact  that,  on  the  side  where  the  struma  is 
more  enlarged  or  the  exophthalmos  more  pronounced, 
the  vagus  on  that  side  responds  to  smaller  degrees  of 
pressure  as  shown  by  inhibition  of  the  pulse. 

In  exophthalmic  goitre,  I  assume  that,  diminished 
vagus-tone  causes  the  sympathetic  fibers  to  become 
dominant  in  action. 

Stimulation  of  the  sympathetic  roots  of  the  2nd  to 
the  4th  thoracic  segments  of  the  cord  will  cause  dila- 
tation of  the  pupil,  exopthalmos  and  tachycardia.  The 

75 


Progressive     Spondylotherapy 

ocular  symptoms  of  exopthalmic  goitre   (490)  can 
easily  be  understood  by  referring  to  fig.  19. 

,  The  cervical  part  of  the  sympathetic  chain  con- 
taining oculo-pupillary  fibers  innervates  the  dilator 
pupillae,  Miiller's  muscle  and  the  non-striated  por- 
tion of  the  levator  palpebrae  superioris.  There  are 
also  fibers  to  the  hyppglossal  nerve  and  sweat  and 
vasomotor  fibers. 


Non-striated   Muscle 
of  upper  Lid. 


Dilator 
Pupillae 

Gassenan  Ganglion 
Mullera  Muscle 


FIG.  19. — Diagram  of  course  of  oculopupillary  fibers  of  the  cervical 
sympathetic.  The  pupil-dilating  fibres  arise  from  the  pupil-dilating  cen- 
ter in  the  medulla,  and  descending  in  the  lateral  column  of  the  cord  they 
emerge  in  the  anterior  roots  of  the  first  and  second  thoracic  segments.  En- 
tering the  interior-cervical  ganglion  by  white  "rami  communicantes,"  they 
ascend  in  the  cervical  sympathetic  to  the  Gasserian  ganglion  and  pass  to 
the  orbit  along  the  ophthalmic  division  of  the  trigeminus.  The  other  half 
of  the  diagram  shows  the  origin  and  course  of  the  cardiac  nerves.  The 
stimulus  applied  at  the  seventh  cervical  spine  corresponds  to  the  third 
dorsal  segment  of  cord  and  approximately  to  the  2nd  and  3rd  dorsal 
nerves. 

The  fibers  to  the  heart  emerge  from  the  cord  in  the 
anterior  roots  of  the  2nd  and  3rd  thoracic  nerves. 

76 


Exophthalmic     Goitre 

If  pressure  is  made  between  the  3rd  and  4th  dorsal 
spines  to  depress  the  vagus,  one  may  reproduce  or 
accentuate  the  ocular  symptoms  of  exophthalmic 
goitre  in  susceptible  subjects  or  in  those  having  this 
disease. 

An  antithetic  effect  is  noted  by  augmenting  vagus- 
tone  (and  consequently  depressing  sympathetic  tone) 
by  pressure  at  the  7th  cervical  spine. 

Insomuch  as  the  cervical  sympathetic  is  accessible 
to  clinical  observation,  it  may  serve  as  an  index  to 
the  condition  of  the  general  sympathetic  system 
and  should  be  tested  as  a  routine  method. 

By  pinching  the  skin  of  the  neck,  the  ciliospinal 
refldx  of  pupillary  dilatation  ensues  on  the  same  side. 
The  cervical  sympathetic  may  be  stimulated  by  con- 
junctival  instillation  of  a  few  drops  of  cocain-solu- 
tion  and  as  a  result  (even  in  the  norm)  there  is  a 
slight  exophthalmos,  mydriasis  and  retraction  of  the 
upper  lid  (in  the  eye  in  which  the  drug  had  been 
instilled). 

One  may  employ  pharmacologic  reactions  in  la.r- 
vated  cases  Ten  minims  of  adrenalin  chlorid  so- 
lution (1-1000)  given  hypodermatically  will  at  once 
accentuate  the  exophthalmos  and  diminish  the  size 
of  the  thyroid.  Pilocarpin  will  ameliorate  both  con- 
ditions. One  may  also  have  recourse  in  diagnosis 
to  biochemical  tests. 

Thyroid-extract  antagonizes  adrenalin  in  its  pu- 
pillodilator  action  on  the  frog's  eye,  and  this  fact 
may  be  employed  in  the  clinical  recognition  of  hy- 
perthyroidism.  This  action  is  obtainable  with  the 
•blood  in  exophthalmic  goitre,  but  is  negative  with 
blood  from  neurasthenic  and  hysterical  subjects. 

The  blood  in  hyperthyroidism  increases  the  resis- 
tance of  mice  to  poisoning  with  morphin  and  ace- 
tonitrile,  thus  making  it  possible  to  double  the  lethal 
dose.  The  blood  findings  in  this  disease  (488)  can 
no  longer  be  regarded  as  characteristic  insomuch  as 
the  same  blood  picture  has  also  been  found  in 
simple  goitre. 

The  leucopenia  is  probably  caused  by  an  excess 
of  thyroid  secretion. 

77 


Progressive     Spondylotherapy 

I  have  found  that  thyroid  feeding  in  a  few  nor- 
mal subjects  will  eventuate  in  a  blood-picture  not 
unlike  that  found  in  exophthalmic  goitre. 

Nothing  can  be  added  to  my  method  of  treatment 
of  this  disease  (490). 

In  some  rebellious  cases,  reinforcement  of  the 
reflexes  (pages  40,  44)  may  be  tried. 

It  is  impossible  to  cite  the  favorable  reports  in  the 
treatment  of  this  disease  by  my  method  received  from 
many  physicians. 


FIG.   20. — Illustrating  the  results  achieved  by  Dr.   S.   Edgar  Bond,   by 
the  author's  method  of  treatment. 


I  shall  content  myself  by  reporting  the  cases  of  Dr. 
S.  Edgar  Bond,  of  Richmond,  Indiana,  insomuch  as 
they  are  accompanied  by  photographs. 

Brothers.  Belonging  to  a  family  of  seven,  all  of 
whom  have  goitres  excepting  a  daughter.  Family 
came  from  the  mountains  of  Tennessee. 

William,  was  refused  work  on  account  of  an  im- 
mense goitre  (vide  photograph).  He  was  treated  by 

78 


Exophthalmic     Goitre 

concussion  of  the  7th  cervical  spine  for  about  3 
months. 

Other  methods  had  failed. 

The  other  brother  Oscar,  had  in  addition  to  a  very 
large  goitre,  dyspnea,  slight  tachycardia  and  other 
symptoms  of  hyperthyroidism. 

The  results  of  treatment  are  noted  in  the  photo- 
graphs (Fig.  20). 

Several  failures  to  get  results  were  found  on  inves- 
tigation to  be  due  to  the  use  of  vibration  in  lieu  of 
concussion. 

The  inutility  of  a  vibration  apparatus  to  elicit 
reflexes  cannot  be  sufficiently  emphasized.  One  can- 
not evoke  the  knee-jerk  by  vibration  and  no  more  can 
be  expected  in  the  elicitation  of  the  vertebral  reflexes 
by  the  same  maneuver. 


79 


Progressive     Spondylo therapy 
CHAPTER  IV. 

THE   DIGESTIVE   APPARATUS. 

ESOPHAGUS — STOMACH— PYLORUS — DUODENAL  ULCER— DORSAL 
GASTRIC  NUCLEUS  OP  RESONANCE — DUODENAL  INTUBATION 
SIGMOID  FLEXURE — INTUBATION  OF  COLON— CONSTIPATION 
— SACRO-ILIAC  PERCUSSION — CIRRHOSIS  OF  THE  LIVER- 
GALL-BLADDER— PANCREAS. 

ESOPHAGUS. — In  cardiospasm,  my  methods  as  cited 
(589)  have  been  useful,  but  it  is  well  to  take  into  con- 
sideration recent  experimental  work  which  shows 
that,  stimulation  of  the  peripheral  ends  of  the  cut 
vagi  contracts  the  entire  esophagus  but  dilates  the 
cardia  whereas  section  of  the  vagi,  without  stimula- 
tion, dilates  the  lower  part  of  the  esophagus  and  con- 
tracts the  cardia  which  corresponds  to  the  condition 
known  as  cardiospasm.  Therefore  the  vagi  control 
the  esophageal  musculature  and  furnish  a  dilator 
branch  to  the  cardia. 

In  accordance  with  the  foregoing,  cardiospasm  of 
neurosal  origin  would  be  inhibited  by  pressure  or 
concussion  of  the  7th  cervical  spine. 

This  discrepancy  between  my  clinical  and  the 
experimental  results  cited  is  easily  decided  in  favor 
of  the  former.  To  the  end  of  an  ordinary  stomach- 
tube,  I  attached  a  balloon  and  to  the  other  end  a  V- 
shaped  tube  connected  with  an  inflating  apparatus 
and  manometer  (Fig  21). 

Whether  the  balloon  was  inflated  in  the  esophagus 
or  at  the  cardia  (40  cm.),  the  result  on  concussion  at 
the  7th  cervical  spine  was  the  same,  viz.,  contraction 
of  the  esophagus  and  cardia.  On  the  contrary,  concus- 

80 


s 


t 


o 


m 


a 


sion  between  the  3rd  and  4th  dorsal  spines  (to  depress 
vagus)  resulted  in  dilatation  of  the  esophagus  and 
cardia. 

STOMACH. — An  unbiased  and  careful  analysis  of 
the  various  methods  for  outlining  the  stomach  con- 
vince the  author  that  the  vago-visceral  method  (321, 
584)  is  unquestionably  the  best. 


FIG.  21. — Stomach-tube  with  inflatable  balloon,  manometer  and  pump 
for  gauging  the  contractility  of  the  stomach  and  esophagus. 

Auscultatory  percussion  is  unreliable.  Surgery  has 
added  nothing  because  the  stomach  in  the  operating 
room  like  in  the  dissecting  room  is  examined  in  the 
horizontal  position  and  an  anesthestic  (page  82)  still 
further  complicates  the  situation. 

Fixing  the  stomach  by  freezing  and  by  the  use  of 
formalin  reproduce  the  picture  of  an  atonic  and 
•dilated  organ  immediately  after  death. 

Roentgen-ray  pictures  are  equally  untrustworthy 
(586). 

81 


Progressive     Spondylotherapy 

The  situs  of  the  abdominal  viscera  (influenced  by 
the  position  of  the  diaphragm)  as  recorded  by  anat- 
omists is  unrealiable  for  the  reason  that  after  death 
there  is  an  elevation  of  the  diaphragm  and  a  compen- 
satory retraction  of  the  anterior  abdominal  wall. 

THE  STOMACH  AND  ANESTHETICS. — Gwathmey8,  has 
shown  that  oil  of  orange  added  to  ether  produces 
anesthesia  with  less  discomfort,  quicker  results,  no 
preliminary  excitement,  rapid  recovery  from  effects 
with  neither  nausea  nor  vomiting,  with  half  the  quan- 
tity of  ether.  Dr.  Geo.  Jarvis,  of  Philadelphia,  attrib- 
utes these  results  which  I  have  confirmed  to  the  oil  of 
orange  which  when  mixed  with  ether  suppresses  the 
lung  reflex  of  dilatation  and  the  stomach  reflex  of 
dilatation  which  are  evoked  when  ether  is  used  alone 
(319).  The  previous  inhalation  of  oil  of  orange  is 
quite  as  effective  as  its  synchronous  use  with  ether. 

I  have  observed  under  the  microscope  that,  with 
ether  alone,  the  motion  of  ciliary  epithelial  cells  was 
inhibited,  whereas  the  addition  of  orange-oil  to  the 
ether  seemed  to  augment  the  motion  in  question. 
Post-operative  nausea  and  other  symptoms  incident 
to  the  employment  of  an  anesthetic  may  be  inhibited 
by  previous  nasal  cocainization  (207).  The  addition 
of  2  per  cent,  of  antipyrin  to  the  cocain  solution  will 
prolong  its  action. 

THE  PYLORUS. — Concussion  or  pressure  at  the  5th 
dorsal  spine  will  dilate  the  pylorus  (588).  This  fact 
has  been  utilized  for  the  following  purposes : 

1.  To  relieve  pylorospasm  ; 

2.  To  facilitate  rapid  absorption  and  hasten  the 
elimination  of  nauseous  drugs  from  the  stomach ; 

3.  To  eliminate  the  action  of  the  gastric  juice  on 
drugs   destined  for  action   on  the  intestinal  tract 

82 


The  Pylorus 

.(intestinal  antiseptics  and  lactic  acid  bacilli-prep- 
arations) ; 

4.  In  the  treatment  of  gastric  affections ; 

5.  To  aid  duodenal-intubation.* 

As  an  illustration  of  the  fourth  indication,  a  lady 
may  be  cited  whom  I  saw  in  consultation  with  Dr. 
W.  B.  Ryder,  of  Clinton,  Iowa. 

She  almost  invariably  rejected  her  meals,  2  or  3 
hours  after  ingestion.  She  was  very  much  emaciated 
and  all  methods  of  treatment  were  without  avail. 

On  examination  nothing  definite  was  elicited. 

Concussion  of  the  5th  dorsal  spine  was  executed 
two  hours  after  each  meal  to  facilitate  vomiting  of 
the  food  into  the  intestines.  The  results  were  very  sat- 
isfactory. 

It  is  quite  natural  that  some  should  doubt  on 
scientific  grounds  the  results  as  cited.  Throughout 
my  work,  I  have  repeatedly  emphasized  the  fact 
that  no  credence  is  placed  on  therapeutic  effects 
without  scientific  proof. 

Let  one  employ  Klemperer's  oil-test  for  de- 
termining the  motor  power  of  the  stomach.  It  is 
based  on  the  fact  that  oil  is  not  absorbed  in  the 
stomach.  After  washing  the  organ,  100  c.  c.  of 
pure  olive  oil  are  poured  into  the  empty  stomach. 
Two  hours  later,  the  stomach  is  thoroughly  aspirat- 
ed. The  difference  between  the  original  quantity  of 
oil  and  that  withdrawn  indicates  the  condition 
of  the  motor  function. 

In  the  norm  at  this  time  only  20-40  c.  c.  of  oil 
should  be  aspirated.  If,  after  the  ingestion  of  oil 
pressure  is  made  (at  intervals  of  3  minutes)  at  the 
5th  dorsal  spine,  within  10  minutes,  only  5  c.  c.  of 
oil  can  be  recovered  By  aspiration  if  the  motor 
power  of  the  organ  is  comparatively  good. 

It  may  also  be  observed  that  the  dullness  at  the 

*Jutte  (J.  A.  M.  A.,  Feb.  22,  1913),  practices  transduodenal  lavage  in 
enterotoxism. 

83 


Progressive     Sp  on  dylo  therapy 

lower  border  of  the  stomach  caused  by  the  oil 
which  persists  for  about  2  hours  disappears  in  about 
5  minutes  by  the  maneuver  suggested. 

Duodenal  ulcer,  is  characterized  by  pains  occurring 
one  and  a  half  to  four  hours  after  a  meal  due  prob- 
ably to  passage  of  chyme  at  this  period  of  digestion. 
The  pains  in  question  may  be  precipitated  by  opening 
the  pylorus  after  the  manner  suggested. 

Dr.  H.  Jaworski,  of  Paris,  has  reported  to  me  an 
observation  made  by  him,  viz.,  that  by  raising  the 
hyoid  bone,  the  vomiting  of  pregnancy  can  be  inhib- 
ited. On  investigating  this  interesting  phenomenon, 
I  found  that  lifting  the  hyoid  bone  or  the  cricoid 
cartilage  opens  the  pylorus  and  dilates  it  to  a  greater 
degree  than  stimulation  of  the  5th  dorsal  spine. 

When  one  stimulates  the  5th  dorsal  spine,  the  stom- 
ach assumes  a  vertical  position  and  dilatation  of  the 
pylorus  ensues.  Another  phenomenon  is,  that  the 
stomach  is  so  increased  in  tone  that  it  is  possible  to 
percuss  it  without  simultaneous  stimulation  of  the 
vagus  (321).  Repeated  analyses  of  the  gastric-con- 
tents convince  me  that  stimulation  of  the  vagus  (by 
concussion  at  the  7th  cervical  spine)  will  augment  the 
hydrochloric  acid  in  the  stomach. 

The  action  of  gases  on  the  pyloric  reflex  has  been 
investigated  by  Rotky.  The  pylorus  relaxes  imme- 
diately when  oxygen  is  introduced  into  the  stomach 
but  when  carbondioxid  enters,  there  is  a  spasm  of  the 
pylorus  which  relaxes  intermittently  to  permit  its 
escape. 

In  gastric  tympanites,  due  to  an  excess  of  carbon 
dioxid,  magnesium-perhydrol  which  liberates  oxygen 
in  statu  nascendi  should  be  efficient.  It  also  neutral- 
izes an  excess  of  gastric  acid. 

DORSAL  GASTRIC  NUCLEUS  OF  RESONANCE. — Ewart, 

84 


Duodenum 

describes  a  percussion-note  of  increased  resonance 
and  tympanitic  quality  immediately  below  the  infe- 
rior angle  of  the  left  scapula  (2-2^  inches  in  diam- 
eter) which  he  refers  to  the  deep-seated  resonance  of 
the  stomach.  The  severe  and  dangerous  forms  of  heart 
disease  of  mechanical  gastric  origin  is  attributed  by 
Ewart,  to  a  dilatation  of  the  stomach  at  this  point. 

This  interesting  phenomenon  described  by  Ewart 
in  1910,  was  also  described  by  the  writer  in  1900  (84). 

The  area  of  dorsal  tympanitic  resonance  may  be 
increased  or  diminished  by  elicitation  of  the  stomach 
reflexes  (316,  318). 

One  may  readily  determine  the  effects-  on  the  stom- 
ach of  stimulation  of  the  vagus  (concussion  of  7th 
cervical  spine)  by  using  the  apparatus  shown  in 
Fig.  21. 

DUODENAL-INTUBATION.  —  Several  methods  have 
been  suggested  notably,  that  of  Einhorn9,  for  obtain- 
ing the  contents  of  the  duodenum. 

My  method  is  as  follows:  An  ordinary  stomach- 
tube  rounded  at  the  end  and  perforated  is  introduced 
into  the  organ  after  the  conventional  manner,  and 
some  of  the  contents  aspirated  to  compare  it  with  the 
fluid  subsequently  aspirated  from  the  duodenum.  Any 
large  glass  syringe  which  fits  into  the  end  of  the 
stomach-tube  may  be  used.  Next,  an  assistant  main- 
tains pressure  at  the  5th  dorsal  spine,  during  which 
time  the  tube  is  passed  into  the  duodenum. 

If  the  tube  is  in  the  duodenum,  the  aspirated  fluid 
is  wholly  different  from  the  fluid  secured  in  the  pri- 
mary aspiration  from  the  stomach.  It  is  alkaline  in 
reaction  as  a  rule,  and  by  aid  of  the  usual  tests,  the 
presence  of  amylopsin,  trypsin  and  steapsin  may  be 
demonstrated. 

Prior  to  the  introduction  of  the  tube  into  the  duo- 

85 


Progressive     Spondylotherapy 


denum,  the  tube  (while  in  the  stomach)  should  be 
cleansed  by  aid  of  the  syringe  filled  with  some  colored 
fluid.  The  object  of  the  latter  is  to  make  certain  the 
fact  that  the  tube  is  in  the  duodenum.  If  the  latter 
has  been  entered,  aspiration  shows  the  absence  of  the 
colored  fluid.  Reference  to  fig.  22  shows  the  tube  in 
the  stomach  and  duodenum  as  determined  by  pre- 
vious percussion. 


FIG.  22 — Illustrating  the  gastric  and  duodenal  areas  of  percussional 
dullness.  The  continuous  lines  represent  the  stomach  and  duodenum. 
The  broken  line  represents  the  vertical  position  of  the  stomach  during 
the  time  the  pressure  is  maintained  at  the  fifth  dorsal  spine.  Pressure  at 
the  latter  site  not  only  opens  the  pylorus  in  the  norm,  but  also  augments 
the  tone  of  the  stomach  in  the  vertical  position.  D,  duodenum;  S.  T., 
stomach  tube,  determined  by  percussion. 

It  will  be  noted  that,  when  pressure  is  made  at  the 
5th  dorsal  spine  the  tone  of  the  stomach  is  so  in- 
creased that  it  may  be  delimited  by  percussion  just 
the  same  as  though  pressure  were  made  at  the  7th 
cervical  spine. 

There  is  this  difference,  however.  Pressure  at  the 
7th  cervical  spine  does  not  alter  the  situs  of  the  organ, 
whereas  pressure  at  the  5th  dorsal  spine  causes  a 
transition  of  the  organ  from  a  horizontal  to  a  vertical 

86 


FIG.  23. — Skiagram  of  the  stomach  tube  in  the  duodenum. 
The  intubation  of  the  latter  thus  attained  was  effected  by  the  elicita- 
tion   of   the   pyloric  reflex  of  dilatation. 


87 


Progressive     Spondylo  therapy 

position.  Within  one-half  minute  after  pressure 
ceases  at  the  5th  dorsal  spine  the  stomach  resumes  its 
horizontal  position. 

It  will  be  noted  in  Fig.  22  that  the  stomach-tube 
(S.  T-)  may  be  traced  a  considerable  distance  by 
percussion. 

We  have  been  swayed  by  the  dogmatic  dictum  that 
a  percussion  blow  is  only  propagated  to  a  depth  of 
2l/2  inches,  hence  any  airless  structure  beyond  this 
point  will  elude  detection  by  percussion.  This  fallacy 
may  be  easily  disproved  if  one  will  place  a  stomach- 
tube  in  contact  with  the  posterior  surface  of  the  chest 
and  then  by  percussion  of  the  anterior  surface  of  the 
latter,  attempt  to  locate  its  position. 

As  a  rule,  the  clinician  reasonably  skilled  in  percus- 
sion may  locate  the  site  of  the  tube  no  matter  in  what 
position  the  assistant  may  have  placed  it. 

After  introduction  of  a  stomach-tube,  one  may 
determine  by  percussion  its  position  in  the  esophagus 
from  the  6th  dorsal  spine  downwards. 

Duodenal-intubation  as  cited  is  a  rapid  method 
and  is  no  more  difficult  than  the  introduction  of  the 
tube  into  the  stomach.  This  method  suggests  many 
possibilities  in  diagnosis  and  treatment. 

Moulin,  noted  that  one  could  pass  three  fingers 
through  the  pylorus  and  Knapp,  observes  that  the 
duodenum  may  be  entered  with  the  ordinary  stomach- 
tube  in  cases  of  complete  insufficiency  of  the  pylorus. 

A  few  words  of  reference  to  the  duodenum  are  ap- 
posite. The  latter  is  described  by  anatomists  as  the 
most  fixed  and  widest  part  of  the  small  intestine,  hav- 
ing a  diameter  of  3.81  to  5.08  cm.  and  is  curved  like  a 
horseshoe.  From  a  clinical  standpoint  abetted  by  the 
employment  of  the  visceral  reflexes,  unlike  the  stom- 
ach it  does  not  change  its  situs  during  respiration. 
Whereas  the  duodenum  shows  no  respiratory  disloca- 

88 


Sigmoid         Flexure 

tion,  it  is  luxated  downward  with  the  stomach  when 
pressure  is  made  at  the  fifth  dorsal  spine.  This  may  be 
ascertained  if  synchronous  pressure  is  made  in  the 
latter  situation  and  at  the  tenth  dorsal  spine  (which 
augments  duodenal  tone  and  permits  of  its  delimita- 
tion by  percussion.) 

The  clinical  diameter  of  the  duodenum  varies  from 
3  to  5  cm.,  and  averages  a  diameter  of  4.5  cm.  If  syn- 
chronous pressure  is  made  at  the  tenth  dorsal  spine 
(which  increases  duodenal  tone)  and  at  the  eleventh 
dorsal  spine  (which  dilates  the  duodenum),  it  will  be 
shown  that  it  can  be  made  to  dilate  from  2  to  3  cm. 

In  many  instances,  if  the  stomach-tube  is  not  push- 
ed sufficiently  far  into  the  duodenum  only  a  watery 
liquid  is  aspirated,  whereas  if  it  is  pushed  further, 
the  fluid  assumes  a  more  intense  yellow. 

One  must  recall  the  fact  that  the  common  bile-duct 
and  pancreatic-duct  enter  the  duodenum  at  the  am- 
pulla of  Vater,  about  4  inches  from  the  pylorus. 

The  difficulty  of  passing  along  the  horseshoe  duo- 
denum is  essentially  theoretic. 

In  some  instances,  a  smaller  rubber-tube  is  fixed  in 
the  stomach-tube  and  aspiration  of  the  duodenal-con- 
tents is  made  through  the  former. 

SIGMOID-FLEXURE. — The  large  intestine  extends 
from  the  termination  of  the  ileum  to  the  anus.  It  is 
divided  into  the  cecum  (caput  coli),  colon  and  rectum. 
Its  caliber  is  largest  at  the  cecum  and  gradually  de- 
creases in  size  until  it  reaches  the  ampulla  of  the 
rectum  when  it  again  increases  in  size. 

When  the  cecum  is  filled,  it  is  in  close  proximity  to 
the  abdominal  wall. 

* 

The  appendix  is  usually  given  off  from  the  pos- 
terior and  inner  portion  of  the  caput  colt  about 
11-16  of  an  inch  below  the  ileocecal  valve.  The 
average  length  of  the  colon  is  as  follows: 

89 


Progressive     Spondylotherapy 

Ascending  colon 8     inches 

Transverse  colon  20 

Descending  colon  Sy2     " 

The  descending  colon  begins  at  the  splenic  flex- 
ure and  terminates  at  the  sigmoid-flexure.  The  lat- 
ter (S.  romanum},  is  an  S  shaped  curve  about  13 
inches  in  length  beginning  at  the  iliac  crest  and 
ending  at  the  brim  of  the  true  pelvis  opposite  the 
left  sacro-iliac  articulation.  The  sigmoid  is  very 
movable  and  is  the  narrowest  portion  of  the  large 
intestine.  It  has  an  upper,  or  colic  and  a  lower, 
or  rectal  limb. 

According  to  the  measurements  of  anatomists  the 
length  of  the  large  intestine  from  the  caput  coli  to 
the  termination  of  the  rectum  averages  5  to  6  feet. 

These  figures  are  evidently  too  high  for  the  living 
subject.  My  experience  with  colonic-intubation  al- 
ways controlled  by  X-ray  pictures  shows  that  an 
ordinary  stomach-tube  is  more  than  long  enough  to 
traverse  the  entire  large  intestine. 

Respecting  the  functions  of  the  latter,  much  evi- 
dence has  accumulated  to  show  that  it  is  a  useless  and 
dangerous  structure. 

This  latter  statement  was  emphasized  by  Metch- 
nikoff's  book  on  "The  Nature  of  Man"  and  by  Lane, 
who  referred  to  the  cecum  and  ascending  colon  as  a 
cesspool  and  carried  his  conception  into  practice  by 
"short-circuiting"  or  by  excision  of  -the  large  intes- 
tine. 

INTUBATION  OF  THE  COLON. — All  authorities  are 
practically  agreed  that  the  passage  of  a  tube  beyond 
the  sigmoid-flexure  is  impossible. 

Kemp,  observes  that  in  his  experience,  in  -every  at- 
tempt to  pass  the  sigmoid  it  caught  and  coiled  back. 
Owing  to  the  great  mobility  of  this  structure  it  is 
pushed  upward  which  fact  suggests  the  passage  of 
the  tube.  A  flexible  wire  in  a  tube  was  used  but  the 

90 


Sigmoid         Flexure 

X-rays  demonstrated  that  the  passage  of  the  tube 
beyond  the  sigmoid  was  impossible. 

Soper,  after  a  wide  experience  controlled  by  skia- 
grams avers  that  it  is  impossible  to  pass  the  tube  into 
the  sigmoid  except  in  Hirschsprung's  disease  (con- 
genital idopathic  dilatation  and  hypertrophy  of  the 
colon). 


ABC 

FIG.  24. — Illustrating  colonic-intubation;  A  and  B,  tube  coiled  in  the 
rectum;  C,  successful  attempt  to  pass  the  tube  beyond  the  sigmoid  with 
cable  shown  in  Fig  25. 

Prof.  A.  Schmidt,  observes  that  owing  to  the  angle 
formed  by  the  colic  and  rectal  limbs  of  the  sigmoid, 
it  is  impossible  to  pass  any  instrument. 

My  investigations  on  the  subject  embraced  pri- 
marily the  fact  that  the  sigmoid  could  be  dilated  by 
pressure  at  the  llth  dorsal  spine  (326)  and  this  dila- 
tation could  be  demonstrated  by  percussion,  if  syn- 
chronous pressure  (employing  two  radicularpres- 
sors)  were  executed  at  the  1st  dorsal  (592)  and  llth 
dorsal  spines.  For  the  passage  of  the  tube,  pressure 
by  an  assistant  at  the  latter  point  sufficed.  The  pres- 
sure made  by  an  assistant  should  not  at  any  time 
exceed  30  seconds  so  as  to  avoid  exhausting  the  reflex 
and  during  the  pressure  the  tube  is  pushed  (very 
gently)  forward. 

91 


Progressive     Spondylotherapy 


Some  resistance  is  of  course  encountered  but  it  is 
slight. 

The  sigmoid  is  best  straightened  when  the  patient 
stands  and  this  position  is  to  be  favored  whenever 
possible. 

My  primary  attempts  to  pass  the  tube  failed 
completely  as  shown  in  fig.  24. 


FIG.  25 — An  ordinary  stomach-tube  with  flexible  cable  used  for  passing 
the  sigmoid  flexure  in  colonic-intubation.  To  the  end  of  the  cable  is  an  at- 
tachment with  two  openings — One  for  injecting  oil  and  the  other  for  in- 
flation with  air  to  facilitate  the  passage  of  the  instrument  when  neces- 
sary. 

Later,  I  was  almost  invariably  successful  when  a 
strong  flexible  cable  was  introduced  into  the  tube 
(Fig.  25). 

Theoretically,  one  would  regard  the  foregoing  man- 
euver as  harmless  but  two  deaths  from  perforation 
have  ensued  with  recto-sigmoidoscopy.  A  gut  with  a 
rigid  mesentery  may  be  dangerous.  Of  course  serious 
results  have  attended  even  the  passage  of  a  stomach- 
tube  or  urethral-sound.  Pain  is  a  safeguard  in  col- 
onic-intubation and  due  consideration  must  be  given 
to  it. 

92 


Colonic-Intubation 

Colonic-intubation  is  indicated  for  a  variety  of 
conditions : 

1.  To  correct  intestinal  stasis ; 

2.  To  prevent  appendicitis, 

3.  To  introduce  nutrient  enemata. 

4.  To  introduce    medicaments. 

5.  To  facilitate  X-ray  examinations. 

Intestinal  stasis  is  perhaps  the  greatest  contribu- 
tory factor  in  the  genesis  of  intestinal  autointoxica- 
tion (338).  Constipation  is  one  evidence  of  defective 
intestinal  drainage.  Many  of  the  patients  are  treated 
in  vain  for  every  conceivable  neuropathy  or  psycho- 
pathy. Mental  apathy,  acute  attacks  of  abdominal 
pain  (often  relieved  by  the  horizontal  posture), 
headaches,  nausea,  vomiting  and  loss  in  weight  are 
some  of  the  symptoms  of  stasis. 

C.  von  Noorden,  has  recently  directed  attention  to 
wandering  pains  (dolor es  vagi)  due  to  fecal-stasis  in 
the  sigmoid-flexure  which  is  very  sensitive  to  .pres- 
sure. The  condition  is  essentially  an  elective  neuritis 
insomuch  as  the  sensory  fibers  alone  are  affected. 
Associated  symptoms  are:  indicanuria,  arthralgias 
and  slight  elevations  of  temperature  (99.5  to  99.86° 
F.) 

A  bismuth  meal  shbws  delay  in  some  part  of  the 
colon. 

Colonic-stasis  may  be  caused  by  splanchnoptosis, 
kinks,  bands,  adhesions,  etc.  A  definite  blood-picture 
has  been  found  by  Hoxie;  hemoglobin  high  with 
normal  red-blood  count.  Whites,  about  normal.  With 
Wright's  stain,  the  polynuclears  show  an  increase  of 
cells  with  large  ambophilic  granules  (dark,  large  and 
purplish) .  The  latter  decrease  as  the  excretion  of  the 
toxins  increases.  The  degree  of  intoxication  is  in  the 
proportion  of  these  dark  cells  to  the  total  number  of 
polynuclears. 

93 


Progressive     Spondylotherapy 

A  multitude  of  affections,  notably,  asthma,  have 
been  attributed  to  intestinal  stasis  and  Eustis,  has 
cured  many  cases  based  on  this  assumption.  Toxic 
amins  have  been  extracted  from  the  putrefactive 
intestinal-contents  which,  when  injected  into  animals 
cause  bronchial-spasm. 

The  general  appearance  of  these  patients  is  char- 
acteristic :— Cold  and  clammy  hand,  pigmentation 
(sallow  skin),  abdomen  is  distended  and  tenderness 
in  colonic-regions  where  the  x-rays  show  a  delay  of 
the  bismuth  meal.  Nodulation  of  the  upper  and  outer 
quadrant  of  the  breast  is  not  uncommon  and  is  often 
erroneously  called  mastitis  (chronic). 

Perhaps  one  of  the  greatest  contributions  to  sur- 
gery is  that  or  Arbuthnot  Lane,  who  by  his  method  of 
anastomosis  rescues  many  individuals  suffering  from 
chronic  intestinal  stasis. 

How  much  good  colonic-intubation  will  do  for  these 
patients  as  well  as  those  suffering  from  chronic 
appendicitis  can  only  be  decided  by  time.  It  is  evi- 
dent however  that  as  we  are  now  able  to  pass  the  sig- 
moid,  more  thorough  cleansing  of  the  colon  can  be 
effected. 

Duodenal-ulcer  according  to  Moynihan,  is  second- 
ary to  microbic  infection  from  the  lower  tracts  of  the 
alimentary  canal  but  the  chief  role  as  a  source  of 
septic  infection  is  played  by  the  appendix.  The  latter 
structure  is  responsible  for  some  forms  of  intestinal 
stasis  owing  to  the  formation  of  adhesions.  It  has 
been  shown  that  in  the  colon  where  bacterial  action  is 
at  its  maximum,  it  is  a  predisposing  factor  in  carcin- 
oma of  the  colon.  Thus  the  parts  most  frequently 
attacked  in  order  of  frequency,  are ;  sigmoid,  cecum, 
splenic  and  hepatic  flexures  and  transverse  colon.  The 
ascending  and  descending  portions  are  the  least  often 
affected. 

94 


Antiseptics 

Nor  must  we  disregard  colonic-flushing  as  a  pre- 
ventive of  appendicitis. 

No  doubt  infection  is  the  invariable  prelude  to  the 
latter.  The  appendix  is  practically  a  culture  test- 
tube  in  which  feces  and  microorganisms  lodge  and 
are  with  difficulty  discharged.  Inflation  of  the  colon 
with  air  may  reproduce  the  pains  of  appendicitis  in 
subjects  with  recurrent  attacks  and  without  symp- 
toms. 

In  the  conventional  method  of  examining  the  large 
intestine  with  the  x-rays  a  bismuth  meal  is  given  but 
it  takes  12  to  15  hours  to  reach  the  ileocecal  valve,  24 
hours  to  reach  the  transverse  colon  and  36  hours  to 
attain  the  sigmoid. 

Now,  one  can  make  the  examination  immediately 
by  injecting  the  bismuth  (30  ounces)  and  then  having 
the  patient  lie  on  his  right  side  for  several  minutes  to 
enable  the  solution  to  pass  into  the  cecum.  Careful 
investigations  show  that,  intestinal  antiseptics  taken 
.by  the  mouth  are  without  any  apparent  action  on  the 
bacterial  inhabitants  of  the  intestines  and  that  the 
most  effective  means  of  diminishing  the  bacterial- 
content  of  the  large  intestine  is  by  regulation  of  the 
diet  with  evacuation  of  the  bowels.  The  "effects  of 
disintoxicating  the  intestine  by  the  recently  discov- 
ered " Glycobacter"  awaits  development. 

CONSTIPATION. — The  author's  method  of  treatment 
(329)  in  atonic  constipation  may  be  due  in  part  to  the 
expression  from  the  spleen  of  an  hormone.  Zuelzer, 
has  shown  that  intestinal  peristalsis  is  produced  by 
an  internal  secretion  of  the  gastric  mucosa  elaborated 
at  the  acme  of  digestion  and  stored  in  the  spleen. 

CECUM. — In  the  percussion  of  this  structure  (592) 
during  the  time  pressure  is  maintained,  it  will  show 
respiratory  mobility.  Absence  of  the  latter  suggests 
cecal-adhesions. 

95 


Progressive     Spondylotherapy 

RECTUM. — Atony  of  this  structure  may  be  respon- 
sible for  constipation.  The  best  site  for  stimulation 
is  the  5th  lumbar  spine  and  the  best  stimulant  is  the 
rapid  sinusoidal  current. 

The  latter  was  determined  by  using  an  inflated 
vballoon  (Fig  21)  in  the  rectum  and  noting  at  which 
point  of  the  spine  the  needle  of  the  manometer  was 
best  deflected. 

For  spinal  sinusoidalization,  I  use  the  spondylec- 
trode  shown  in  fig.  26. 


FIG.  26 — Spondylectrode. — The  distance  between  the  two  electrode 
discs  is  just  sufficient  to  span  the  spinous  processes,  making  contact  with 
the  nerves  on  each  side. 

When  the  little  lever  marked  "A"  connects  the  two  metal  plates  to- 
gether, and  the  connecting  cord  is  attached  to  socket  marked  "B",  the 
electrode  is  monopolar;  while  an  indifferent  pad  must  be  applied  else- 
where. 

When  the  lever  marked  "A"  is  open,  with  one  cord  at  "B"  and  one  in 
socket  "C",  the  electrode  is  bipolar. 

The  current  can  be  interrupted  by  means  of  the  interrupter  on  handle; 
or  can  be  made  continuous  by  sliding  the  ring  "D"  down  over  the  inter- 
rupter to  hold  it  stationary. 

The  two  small  discs  are  provided  for  diagnostic  effects  over  motor 
points  and  two  larger  discs  for  therapeutic  application  to  muscles. 

SACRO-ILIAOPERCUSSIOX. — Dr.  William  Ewart10, 
who  has  displayed  so  much  genius  in  devising  new 
methods  of  examination  has  recently  suggested  a 

96 


Cirrhosis     of    the     Liver 

dorsal  field  of  percussion  which  includes  the  resonant 
sacral  and  iliac  surfaces  (Fig.  27). 

In  the  norm,  there  are  as  shown  in  fig.  27,  two  pos- 
terior iliac  patches  of  subresonant  dullness  due  to  the 
common  iliac  blood-vessels. 

In  appendicitis,  there  is  a  dullness  extending  from 
the  right  normal  patch  of  dullness  over  the  normal 
resonant  sacral  and  iliac  surfaces.  The  latter  is  often 
more  positive  than  the  usual  abdominal  examination 
owing  to  the  predominance  of  retrocecal  appendicitis. 

In  investigating  this  new  method,  I  found  that  a 
fecal  impaction  of  fecas  in  the  cecum  will  yield  an 
increased  area  of  dullness  on  the  right  side  and  fecal 
impaction  in  the  rectum  will  increase  the  area  on  the 
left  side. 


FIG.    27. — Illustrating   sacro-iliac   percussion;    N,   normal   areas   of   dull- 
ness; CC,  dullness  of  "caput  coli"  and  R.  dullness  of  the  rectum. 

Even  in  the  norm,  pressure  with  the  radicular- 
pressor  at  the  12th  dorsal  spine  will  yield  a  dull  area 
corresponding  to  the  cecum  and  pressure  at  the  4th 
lumbar  spine,  a  dullness  corresponding  to  the  rectum 
which  extends  from  about  the  3rd  sacral  spine  to  the 
coccyx  (Fig.  27).  Percussion  of  the  cecum  in  front 
has  already  been  studied  (592). 

CIRRHOSIS   OF   THE   LIVER. — No    inconvenience    is 

97 


Progressive     Spondylotherapy 

usually  suffered  in  this  affection  provided  the  com- 
pensatory circulation  is  maintained. 

In  cirrhosis,  the  various  anastomoses  between  the 
systemic  and  portal  circulations  are  insufficient  to 
overcome  the  effects  of  an  occluded  portal  circulation. 

Surgery  has  been  utilized  by  the  operation  of  Tal- 
ma, which  consists  of  establishing  a  communication 
between  the  systemic  and  portal  circulations  thus 
causing  adhesions  to  form  between  the  great  omen- 
turn,  liver,  spleen  and  parietal  peritoneum.  This 
operation  is  effective  in  about  50  per  cent,  of  the 
cases. 

In  the  Routte  operation,  the  saphenous  vein  is 
anastomosed  to  the  peritoneum. 

Whether  the  liver  is  enlarged  or  contracted,  the 
clinical  symptoms  are  practically  the  same. 

I  have  treated  several  cases  of  cirrhosis  with  con- 
traction with  relief  of  toxic  and  obstructive  symp- 
toms by  evoking  the  liver  reflex  of  dilatation  (338). 

GALL-BLADDER. — I  have  requested  several  of  my 
surgical  friends  to  confirm  my  method  of  locating  the 
gall-bladder  (598).  Dr.  Geo.  Jarvis,  of  Philadelphia, 
and  Dr.  D.  C.  Ragland,  of  Los  Angeles,  have  corrob- 
orated my  findings.  The  gall-bladder  was  percussed 
and  outlined  by  a  stick  of  nitrate  of  silver  and,  at  the 
operation,  it  was  found  in  the  situation  located  by 
percussion.  I  wish  to  suggest  the  possibilities  of  a 
new  "physiologic  surgery"  by  methods  for  eliciting 
the  vertebral  reflexes.  Thus,  the  location  of  the  seg- 
ment for  dilating  the  ureter.  Such  data  are  only 
possible  at  the  time  of  an  operation. 

Dr.  George  Jarvis,  an  indefatigable  investigator  on 
these  lines  found  that  manipulation  of  the  pancreas 
increases  vagus-tone  as  determined  by  slowing  of  the 
heart  and  contraction  of  the  stomach. 

PANCREAS. — Since  using  my  method  of  duodenal- 

98 


Pancreas 

intubation  (page  85),  I  have  found  that  stimulation 
of  the  10th  dorsal  spine  will  augment  the  pancreatic 
secretion. 

I  do  not  know  whether  its  internal  secretion  would 
be  similarly  influenced.  This  internal  secretion  influ- 
ences carbohydrate  metabolism.  Lesions  of  the  isl- 
ands of  Langerhans,  are  found  in  a  large  percentage 
of  cases  in  diabetes.  The  author  suggests  that  stimu- 
lation of  the  10th  dorsal  spine  be  tried  in  cases  rebel- 
lious to  the  method  already  advocated  (283,  479). 

Pawlow,  believed  that  stimulation  of  the  vagus 
directly  influenced  pancreatic  secretion. 


99 


Progressive     Sp  on  dylo  therapy 
CHAPTER  V. 

MISCELLANEOUS   REFLEXES   AND  DATA 

VERTEBRAL  REFLEXES  IX  GYNECOLOGY — PELVIC  SPLAXCHXOP- 
TOSIS— MAMMARY  TUMORS — PERTUSSIS— COUGHS — MEDULLA 
OBLOXGATA— LOCOMOTOR  ATAXIA— SPLEEX— EDEMA— EYE  — 
SPQXDYMOBILE  GAUGE. 

VERTEBRAL  REFLEXES  IN  GYNECOLOGY. — The  follow- 
ing are  some  extracts  from  a  very  interesting  contrib- 
ution by  Charles  L.  Ireland,  M.  D.,  of  Columbus, 
Ohio,  read  before  "The,  American  Association  for  the 
Study  of  Spondylotherapy"  (Nov.  12,  1912). 

The  following  clinical  picture  is  the  average  one  of 
the  patient  who  presents  herself  to  the  physician  for 
treatment.  She  is  very  sad,  has  bearing  down  pains 
in  the  pelvis,  backache,  headache,  irregular  menstrua- 
tion, leucorrhea,  and  pains  practically  everywhere. 
Areas  of  vertebral  tenderness  suggest  valuable  diag- 
nostic information.  Thus,  tenderness  at  the  4th  lum- 
bar spine  suggests  a  disease  of  the  uterus ;  3d  lumbar 
vertebrae,  ovaries;  2nd  lumbar  on  the  right  side, 
appendix ;  10th,  llth  or  12th  dorsal  vertebrae,  renal 
disease,  etc. 

Many  of  these  so-called  cases  of  uterine  disease 
were  treated  by  every  available  method  without  suc- 
cess until  it  was  found  that  the  underlying  condition 
was  essentially  splanchnic  neurasthenia  (337,  432). 
Treating  the  latter  by  the  sinusoidal  current,  it  was 
soon  found,  that  in  the  absence  of  adhesions,  dislo- 
cated uteri  (weighted  by  the  large  accumulation  of 
blood  in  the  splanchnic  vessels)  were  restored  to  the 
norm. 

Subinvolution  of  the  uterus  failing  to  respond  to 

100 


Pelvic        Viscera 

the  conventional  treatment  yields  to  methods  for  elic- 
iting the  uterus  reflex  (358). 

"I  will  say  here  that  up  to  one  year  ago  I  had 
always  contended  that  when  an  ovary  was  prolapsed, 
surgery  was  the  only  recourse,  and  I  had  good  reasons 
for  so  thinking.  By  the  use  of  the  sinusoidal  current 
to  provoke  the  uterus  reflex,  absolute  cure  resulted 
in  9  cases,  *.  e.,  reposition  of  the  ovaries  ensued". 

The  author  suggests  the  neologism,  "pelvic 
splanchnoptosis"  to  describe  ptoses  of  the  pelvic 
viscera  caused  by  relaxation  of  the  ligaments  (420). 

In  prolapsus  uteri,  with  its  complications  (recto- 
cele  and  cystocele),  operations  usually  fail  if  the 
perineum  (and  not  the  ligaments)  is  regarded  as  the 
only  support  of  the  pelvic  organs.  All  the  viscera  are 
held  in  place  by  suspension  from  above  and  the  pelvic 
viscera  are  not  exceptions.  Eelatively  speaking,  the 
uterus  has  more  ligaments  than  any  other  viscus  and 
the  round  ligaments  can  sustain  a  weight  of  about  10 
pounds.  Even  in  complete  laceration  of  the  perineum 
the  uterus  may  remain  in  place  thus  showing  the 
importance  of  the  ligaments  as  supports. 

Splanchnoptosis  is  further  discussed  on  page  185. 

Reference  has  already  been  made  to  abdominal 
supporters  (145)  and  the  methods  for  testing  their 
efficiency  (146). 

Dr.  Nathan  Rosewater,  of  Cleveland,  describes  the 
following  three  distinct  types  of  devices  for  support- 
ing the  abdomen : 

1.  The  corset  type  is  a  rigid,  usually  more  or 
less  metallic  corset,  shaped  to  hold  and  support  the 
protruding  belly.  These  have  the  advantage  of  fol- 
lowing the  fashion  for  women,  supporting  the 
spinal  muscles,  also  they  do  not  allow  of  much 
motion  of  individual  muscles.  Some  are  too  ex- 
pensive for  the  masses.  Those  corsets  lacing  in 

101 


Progressive     Spondylotherapy 

front,  of  moderate  price,  answer  very  well  provided 
patients  are  taught  to  put  them  on  while  lying  on 
their  hack,  to  secure  the  organs  in  proper  place 
before  the  protrusion  of  the  abdomen  and  down- 
ward drag  of  the  viscera  can  occur. 

2.  The  zinc  oxide  adhesive  plaster  (531). 

3.  Elastic  or  supporting  belts.  These  are  a  more 
or  less  elastic  supporter  or  belt  of  varied  mater- 
ials and  forms,  fixed  with  straps  and  buckles  for 
lifting,  holding  and  supporting  the  protruding  ab- 
domen and  preventing  its  downward  drag.  Most  of 
these  are  too  complicated  for  description  and  im- 
practical.    A  simple,  practical  form,  which  Rose- 
water  uses,  is  illustrated  in  Fig.  28.    Unlike  most  of 
the  others,  it  has  no  perineal  support  to  irritate 
and  chafe  between  the  legs  in  hot  weather,  but  the 
main  anterior  body,  A,  of  the  supporter  is  held 
anchored   to    its   place   by    a    strong   rubber   belt, 
buckled  to  it  at  its  lower  outer  angle  on  the  right, 
which    passes   outward    and    downward   over    the 
hip,  under  the  gluteal  folds  (which  prevents  it  from 
slipping  up).     It  is  buckled  into  the  upper  right 
margin  of  the  supporter   A,  and  passes  upward, 
backward,  and  crossing  over  the  back  to  the  corres- 
ponding upper  left  buckle. 

These  belts  are  instantly  adjusted  to  any  tight  or 
loose  condition  required,  and  can  be  let  out  for  wo- 
men during  their  entire  pregnancy,  growing  stout 
or  thin  only  requires  adjustment  by  letting  in  or  out 
of  the  rubber-belt,  which  is  made  long  enough  if 
desired.  For  longer  periods  of  wear,  and  after 
laparotomy  and  other  operations,  this  type  of  belt 
is  inexpensive,  simple,  durable  and  practical.  As 
will  be  seen  in  the  cuts,  the  support  secured  is  up- 
ward and  backward,  corresponding  to  the  natural 
support  given  by  the  abdominal  muscles.  It  is  best 
to  lie  on  the  back  in  adjusting  this  belt,  as  also 
with  any  form  of  abdominal  support  or  corset.  The 
author  after  testing  various  abdominal  belts  uses 
the  Rosewater  belt  (Fig.  28)  to  the  exclusion  of 
others  whenever  possible. 

Mammary  Tumors. — Pseudo-neoplasms  (198)  can 
be  made  to  temporarily  disappear  by  pressure  cor- 
responding to  the  sensitive  vertebral  point  by  aid  of 

102 


Mammary         Tumors 

the  algesispondyloscope.  Insomuch  as  the  object  is 
to  inhibit  impulses  in  the  spinal  nerve,  the  pressure 
must  exceed  two  minutes  in  duration.  I  have  observed 
that  true  neoplasms  of  the  gland  appear  to  be  larger 
than  they  are  found  at  the  time  of  the  operation. 
This  is  probably  caused  by  the  coincident  muscular 
spasm  provoked  by  the  presence  of  the  growth  for, 
if  the  conductivity  of  the  nerve  or  nerves  innervating 


FIG.  28. — The  Rosewater  abdominal  belt. 

the  breast  is  inhibited  (171)  the  intumescence  caused 
by  the  spasm  disappears  temporarily  and  only  the 
true  growth  remains. 

Pertussis. — Dr.  W.  T.  Baird,  of  El  Paso,  has  made 
a  most  important  contribution  to  the  therapeutics  of 
this  disease. 

His  treatment  is  based  on  the  fact  that  the  supposi- 
tions organisms  of  this  affection  have  their  habitat  in 
the  mouths  of  the  sublingual  glands.  The  duct-open- 
ings in  this  disease  are  red  and  swollen.  The  lesions 
are  first  dried  and  then  touched  in  succession  with  a 
probe  around  which  cotton  is  wound  and  carrying  one 
drop  of  carbolic  acid.  By  this  treatment  the  disease 

103 


Progressive     Spondylotherapy 

may  be  aborted  in  24  hours  in  the  early  stages.  It 
may  be  necessary  to  repeat  the  application  on  several 
successive  days.  Neither  pain  nor  soreness  follows. 
In  later  stages,  cure  is  effected  in  about  one  week. 
In  advanced  cases  concussion  of  the  7th  cervical  spine 
is  advocated  (624). 

COUGHS. — Dr.  D.  V.  Ireland,  has  succeeded  in  in- 
hibiting many  forms  of  persistent  cough  (which  had 
resisted  conventional  methods)  notably  in  bronchitis 
by  freezing  sensitive  areas  corresponding  to  the  upper 
dorsal  vertebrae.  Here,  there  are  probably  irritable 
foci  which  survive  the  disease  (439). 

In  tuberculosis,  writers  have  directed  attention  to 
the  low  position  of  the  diaphragm  and  have  accounted 
for  it  in  a  variety  of  ways.  In  a  personal  communi- 
cation, Pottenger,  suggested  an  ingenious  reason.  He 
believes  it  to  be  caused  by  irritation  of  the  phrenic 
nerve  innervating  the  pleura  (549).  To  test  the  cor- 
rectness of  his  observation,  I  have  often  found  in 
phthisis  sensitive  points  corresponding  to  the  exit  of 
the  nerve  (2nd  and  3rd  cervical  spines)  and  when  the 
latter  were  frozen  the  diaphragm  assumed  a  higher 
position. 

MEDULLA  OBLONGATA. — It  occurred  to  the  author 
that,  if  one  could  influence  the  cerebral  cortex  by  sin- 
usoidalization  (383),  a  like  influence  could  be  elicited 
by  stimulation  of  the  medulla.  It  was  found  that, 
when  a  large  electrode  was  placed  at  the  sacrum  and 
a  small  interrupting  electrode  over  the  medulla  and  a 
rapid  very  strong  sinusoidal  current  was  used,  the 
facial  and  other  muscles  supplied  by  the  cranial 
nerves  could  be  made  to  contract.  This  method  sug- 
gests itself  in  diseases  of  the  ~bulbar  nuclei. 

LOCOMOTOR  ATAXIA. — In  a  report  to  the  "French 
Academy  of  Medicine"  (Aug.  21,  1912),  Marie  and 
Jaworski,  reported  their  results  with  vertebral  reflex- 

104 


Peripheral         Pains 

otherapy  (616)  in  advanced  tabes.  They  observed 
that  10  minutes  treatment  by  the  latter  method  was 
equivalent  to  6  months  treatment  by  the  methods  of 
Fraenkel  (165)  and  that  this  progress  after  several 
seances  was  permanent.  It  is  impossible  to  delimit 
our  conception  of  tabes  and  Schwab,  has  truly  said 
that  all  progress  in  neurology  is  commensurate  with 
the  progress  made  in  tabes.  '  Even  our  present  con- 


PIG.  29. — Concussor  for  executing  unilateral  concussion-analgesia. 

ception  of  the  disease  as  a  radiculitis  (implying 
involvement  of  the  posterior  roots),  is  handicapped 
by  the  fact  that  radicular  lesions  are  present  in  other 
conditions,  notably  in  syphilis. 

PERIPHERAL  PAINS. — These  may  be  inhibited  by 
concussion-analgesia  (367).  It  is  not  necessary  to 
evoke  bilateral  analgesia  if  one  uses  a  special  concus- 
sor  (Fig.  29)  on  one  side  of  the  spinous  processes. 
Localizing  the  point  for  concussion  has  been  discussed 
(369).  In  paravertebral  blocking  of  nerves  (362), 
the  vertebral  point  for  the  injection  may  be  similarly 

105 


Progressive     Spondylotherapy 

located.    It  is  not  necessary  to  introduce  the  needle 
very  far. 

By  injecting  the  Schleich  formula  at  different 
depths  and  manipulating  the  peripheral  sensitive 
point,  the  insensitiveness  of  the  latter  indicates  that 
the  needle  has  penetrated  sufficiently  far.  Next,  the 
syringe  is  detached  from  the  needle  and  filled  with 
alcohol  (423)  which  is  then  injected  when  perm- 
anent effects  are  desired. 

SPLEEN. — Reference  has  already  been  made  to  the 
reflexes  of  the  spleen  (352)  and  it  has  been  shown 
that,  by  contracting  this  organ,  one  is  able  to  precip- 
itate a  paroxysm  of  malaria  (355). 

At  a  recent  meeting  of  "The  American  Electro- 
Therapeutic  Association"  (Sept.  3,  1912)  Dr.  Louis 
von  Cotzhausen,  referred  to  a  physician  who  suffered 
from  latent  malaria  for  a  number  of  years  and  in 
whom  a  typic  paroxysm  of  malaria  was  evoked  within 
an  hour  after  concussion  of  the  upper  three  lumbar 
vertebrae  to  contract  the  spleen. 

It  is  known  that  the  agglutination  test  of  Widal,  in 
typhoid  fever  may  not  appear  until  late  in  the  course 
of  the  disease  or  during  a  relapse. 

In  several  instances,  the  author  has  precipitated  an 
early  and  more  decided  reaction  by  previous  concus- 
sion of  the  lumbar  spines  to  elicit  the  spleen  reflex  of 
contraction. 

Of  course,  no  great  value  can  be  attached  to  these 
limited  observations  and  Prof.  Widal,  has  promised 
to  give  the  method  in  question  a  more  extended  trial. 

FUNCTIONS  OF  THE  SPLEEN. — The  functions  of  this 
organ  are  undetermined  despite  all  the  experiments 
which  have  been  made.  Taking  advantage  of  the 
physiologic  fact  that,  the  spleen  undergoes  rhythmic 
variations  in  volume,  I  sought  to  duplicate  the  same 
by  dilating  the  organ  by  concussion  of  the  llth  dorsal 

106 


Functions       of       the       Spleen 

spine  and  contracting  it  by  concussion  of  the  2nd  lum- 
bar spine. 

Examinations  of  the  blood  were  made  by  Dr.  Al- 
fred Roncovieri,  and  the  following  conclusions  were 
formulated ; 

Concussion  of  the  llth  dorsal  spine  (which  en- 
larges spleen)  produces  an  increase  in  the  number  of 
red-cells  and  hemoglobin.  No  effect  was  noted  on  the 
white-cells. 

No  morphologic  changes  were  noted  in  the  red-cells 
after  concussion. 

Concussion  of  the  2nd  lumbar  spine  (which  con- 
tracts spleen),  increases  the  number  of  white-cells 
chiefly  those  of  the  lymphocytic  type.  No  effect  on 
red-cells  or  hemoglobin. 

Alternate  concussion, of  the  2nd  lumbar  and  llth 
dorsal  spines  increases  the  red  and  white-cells  and 
hemoglobin. 

Unless  the  2nd  lumbar  spine  is  concussed  last,  the 
results  as  cited  do  not  ensue  but  if  it  is  concussed  last, 
the  increase  in  the  number  of  red  and  white-cells  is 
greater  than  when  either  the  llth  dorsal  or  2nd  lum- 
bar spine  is  individually  concussed. 

1.  Average  increase  of  erythrocytes  after  concus- 
sion of  the  llth  dorsal  spine  only 300,000 

2.  Average    percentage-increase    of    hemoglobin 
after  concussion  of  llth  dorsal  spine  only.. 5  per  cent. 

3.  Average  increase  of  leucocytes  after  concussion 
of  2nd  lumbar  spine  only 2800 

4.  Average  increase  of  red-cells  'after  alternate 
concussion 650,000 

Average  increase  of  hemoglobin  after  alternate 
concussion 10  per  cent. 

Average  increase  of  leucocytes  after  alternate  con- 
cussion   3200. 

107 


Progressive     Spondylotherapy 

EDEMA. — The  author's  conception  of  edema  has 
already  been  cited  (617). 

A  more  recent  theory  is  that  of  Fisher,  and  which 
has  been  exploited  in  his  book,  "Nephritis;  An  Ex- 
perimental and  Critical  Study  of  its  Nature,  Cause 
and  the  Principles  of  its  relief;  1912." 

He  assumes  that  edema  is  caused  by  an  excessive 
production  or  accumulation  of  acid  in  the  cells  of  the 
kidney.  His  theory  however,  only  explains  the  imbi- 
bition of  fluid  by  the  cells  whereas  in  edema,  the 
water  is  chiefly  in  the  tissues  outside  the  cells. 

Moore11,  in  an  ingenious  analysis  of  this  theory 
concludes  that  it  is  based  "on  a  minimum  of  experi- 
mental evidence  and  has  no  place  in  the  practice  of 
medicine."  In  my  opinion,  the  most  serious  draw- 
back of  Fisher's  theory  is  the  sweeping  generalization 
of  attributing  all  forms  of  nephritis  to  the  same  cause. 

Fisher  used  successfully  solutions  of  sodium  car- 
bonate and  sodium  chlorid  by  rectal  injections  in 
nephritics  in  coma  with  anuria. 

BLADDER. — Supplementing  the  observations  con- 
cerning the  bladder-reflex  (358),  recent  cystoscopic 
examinations  made  with  Dr.  V.  G.  Vecki  and  Dr. 
Henry  Meyer,  show  that  the  spondylectrode  (Fig.  26) 
is  excellent  for  the  elicitation  of  the  reflex  in  ques- 
tion. The  endoscope  shows  that  the  verumontanum 
is  best  contracted  when  the  spondylectrode  is  applied 
at  the  1st  lumbar  spine.  I  would  suggest  further 
experiments  along  these  lines  by  connecting  a  cath- 
eter, with  a  manometer  after  filling  the  bladder  with 
an  antiseptic  solution  and  then  noting  thy  effects  of 
vertebral  stimulation. 

EYE.— Amblyopia  and  asthenopia  are  often  de- 
pendent on  reduced  vagus-tone  (496). 

They  may  be  artificially  reproduced  by  depressing 

108 


Glaucoma 

the  vagus  and  by  augmenting  the  tone  of  the  latter 
the  conditions  in  question  may  be  improved  or  cured. 

In  the  norm,  the  degree  of  depression  of  the  vagus 
necessary  to  produce  either  condition  may  be  accu- 
rately gauged  by  the  spondylopressor  (Fig.  1). 

While  the  patient  is  reading  test  types,  the  vagus 
is  gradually  depressed  by  pressure  between  the  3rd 
and  4th  dorsal  spines  and  the  degree  of  pressure 
necessary  to  produce  symptoms  is  noted.  By  this 
method  ocular  fatigue  can  be  measured.  Howe,  has 
recently  devoted  himself  to  a  like  study  by  means  of 
an  ophthalmic  ergograph. 

A  physician  in  commenting  on  my  reflex  signs  of 
ocular  disturbances  (443)  refers  to  an  oculist  of 
prominence  who  never  felt  satisfied  that  glasses  were 
correct  until  an  examination  of  the  cervical  and 
dorsal  regions  showed  absolute  muscular  relaxation. 

.GLAUCOMA. — The  exact  cause  of  this  condition  is 
unknown  and  its  pathology  is  explained  by  the  in- 
crease in  intraocular  pressure  and  the  coincident 
venous  congestion. 

Many  theories  have  been  suggested  to  explain  the 
increased  tension  but  all  that  is  really  known  is,  that 
a  disturbed  relationship  exists  between  intraocular 
secretion  and  excretion.  . , ; 

To  determine  the  effects  of  concussion  in  several 
cases,  it  was  found  that  the  best  results  for  reducing 
tension  (as  determined  by  a  tonometer)  and  improv- 
ing vision  was  at  the  7fh  cervical  spine.  Here  the 
effect  was  to  increase  vagus-tone.  Vagus-tone  was 
very  much  diminished  in  the  foregoing  cases. 

The  method  of  treatment  indicated  is  merely  a  sug- 
gestion. 

SPONDYMOBILE    GAUGE. — This   ingenious    contriv- 

109 


Progressive     Spondylo  therapy 

ance  (Fig.  30),  of  Langworthy,  is  used  for  measuring 
the  mobility  of  the  vertebrae. 


FIG.    30. — Spondymobile   gauge. 

The  thumb  screw  "C"  is  first  loosened  and  the 
rubber  feet  "A"  and  "B"  are  firmly  planted  on  two 
vertebrae  with  patient  in  an  upright  position.  The 
circular  dial  is  then  turned  so  that  the  pointer  "D" 
rests  at  "O"  and  the  patient  is  instructed  to  stoop 
forward  as  far  as  possible ;  the  pointer  advancing  to 
the  mark  indicating  in  centimeters  the  mobility  be- 
tween the  vertebrae  is  thus  measured.  The  reading  is 
then  recorded,  the  upright  position  once  more  as- 
sumed and  with  pointer  at  "O"  and  instrument  ap- 
plied as  before,  the  patient  is  requested  to  bend 
backwards  as  far  as  possible,  while  the  reading, 
noted  to  be  on  the  opposite  side  of  the  zero  mark, 
is  again  recorded. 

If  desired  to  obtain  in  one  reading  the  sum  of  the 
entire  forward  and  backward  movement,  the  patient 
may  be  instructed  to  bend  forward,  the  rubber  feet 
applied  to  the  vertebrae  under  consideration,  the 
dial  adjusted  so  that  pointer  rests  at  "O"  and  the 
patient  requested  to  straighten  the  back  and  to  comr 
tinue  bending  backwards  as  far  as  possible. 

110 


Spondymobile       Gauge 


The  scale  on  the  dial  indicates  the  range  of 
movement  of  the  vertebral  column,  while  the  figures 
on  the  curved  bar  show  in  centimeters  the  entire 
span  between  the  vertebrae  measured. 


Ill 


APPENDIX 

PHYSIOLOGICAL  PHYSICS  OF  THE 
VARIOUS  FORMS  OF  FORCE 


PHYSIOLOGICAL  PHYSICS  OF  THE 

VARIOUS  FORMS  OF  FORCE 


CHAPTER  VI. 


EXORDIUM  —  ELECTRONIC  THEORY  —  PH^SIOTHERAPEUTICS  — 
PHYSIOLOGIC  PROOF— REFLEXES— SPINAL  CONCUSSION— PER- 
CUSSION OF  THE  STOMACH— BIOPLASM. 

EXORDIUM. — To  thoroughly  understand  this  and 
subsequent  chapters,  it  is  assumed  that  the  reader  is 
conversant  with  the  preceding  pages  and  the  author's 
work  on  "  SPONDYLOTHERAPY"  (Physio-therapy  of 
the  spine  based  on  a  study  of  clinical  physiology).  De- 
spite this  assumption  however,  an  endeavor  will  nev- 
ertheless be  made  to  simplify  the  presentation  of  the 
subject-matter.  If  technecalities  are  employed  they 
will  be  italicized  and  defined  in  an  appended  glossary. 

ELECTRONIC  THEORY. — The  physical  world  may  be 
comprehended  within  the  limits  of  Force*  and  Mat- 
ter. Force  is  that  which  acts  upon  matter  and  the 
latter  is  that  by  which  we  understand  force. 

The  whole  domain  of  physics  is  tending  toward  a 
unification  of  the  various  forms  of  force  under  one 
great  principle.  This  tendency  is  suggested  by  the 
transmutation  of  various  forms  of  force  such  as  the 
conversion  of  sound  into  electricity  and  of  electricity 

*We  shall  employ  the  term  of  force  as  a  matter  of  convenience.  Tech- 
nically, the  word  force  is  wrong  if  used  in  any  way  that  implies  its  ob- 
jectivity, insomuch  as  energy,  is  the  objective  thing  concerned  and  force 
indicates  its  rate  of  change. 

115 


Progressive     Spondylotherapy 

into  heat,  light,  motion  or  chemical  energy.  Heat, 
light,  electricity  and  magnetism  are  under  the  influ- 
ence of  one  or  two  mechanic  conceptions: — that  of 
ether  and  that  of  ultimate  particles  which  embody 
matter  and  electricity. 

Matter  is  an  accumulation  of  positive  and  negative 
electric  charges  and  the  chemic  elements  are  merely 
varying  numbers  and  arrangements  of  these  charges. 

Atoms  are  supposed  to  be  infinitesimal  oppositely 
charged  particles  known  as  electrons,  the  electric 
units  of  nature.  The  latter  move  in  orbits  and  are 
thrown  off  from  all  highly  heated  or  electrified  bodies. 
In  accordance  with  this  theory,  matter  and  force  are 
identical.  The  electrons  bombard  space  and  its  con- 
tents at  the  rate  of  from  50,000  to  100,000  miles  per 
second. 

If  one  observes  a  particle  of  radium  through  a 
little  instrument  with  a  magnifying  glass  known  as 
the  Spinthariscope,  one  may  see  a  display  of  scintil- 
lating bodies  flying  around  like  shooting  stars  and 
bombarding  a  little  screen  covered  with  sulphite  of 
zinc.  The  light  effects  are  caused  by  explosion  of 
the  rays  each  time  they  strike  the  crystals  of  zinc- 
sulphite. 

Despite  the  vulgar  prejudice  of  the  absolute  dis- 
tinction of  mind  and  matter,  they  are  but  two  aspects 
of  the  same  thing. 

It  is  difficult  to  conceive  the  mind  as  a  simple  think- 
ing organ ;  on  the  contrary,  it  is  psychodynamic  and 
must  be  regarded  as  a  force,  like  heat,  light  and  elec- 
tricity. This  dynamogenic  of  force-producing  power 
of  mind  can  be  demonstrated  (page  188). 

The  discovery  of  radium  has  exploded  old  theo- 
ries. It  was  formerly  supposed  that  a  substance  was 
composed  of  atoms  held  together  by  a  kind  of  ce- 
ment like  the  bricks  of  a  brick-wall.  Every  phenom- 

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Electronotherapy 

enon  in  nature  is  dependent  upon  matter  in  motion. 

A  moving  electron  radiates  ethereal  waves  and  a 
flying  column  of  electrons  produces  a  magnetic  field 
in  circles  around  the  moving  electrons  as  a  center. 

Electricity  is  an  invariable  property  of  matter.  In 
this  sense,  electricity  is  not  a  form  but  a  vehicle  of 
energy  which  can  be  moved  from  place  to  place  in 
the  form  of  motion  or  of  strain.  In  motion,  it  is 
current  and  magnetism;  under  strain,  it  is  charge 
and  in  vibration,  it  is  light. 

PHYSIO-THERAPEUTICS.— The  term  physiatrics  is 
used  to  designate  the  natural  forces  employed  by  the 
physician  in  the  treatment  of  disease.  The  action  of 
heat,  light  and  other  forces  is  so  little  understood 
and  used  so  indiscriminately  with  neither  rhyme  nor 
reason  that  any  good  results  attained  by  their  use  is 
attributed  to  suggestion. 

Suggestion  is  often  employed  as  a  term  of  reproach 
and  is  a  most  serious  menace  to  progress  in  the  ac- 
ceptance of  medical  observations.  Lotze  affirms  that, 
our  apprehension  of  the  world  is  one  prolonged  de- 
ception and  Taine,  in  his  book  on  "Intelligence,"  as- 
serts that,  all  perception  is  hallucination,  although  in 
some  instances  it  may  be  shown  to  be  true.  The  cred- 
ulous in  medicine  believe  too  much  and  the  skeptics 
believe  too  little. 

One  must  confess  that  drugs  may  likewise  act  as 
excellent  vehicles  for  suggestion. 

Take  a  force  like  electricity  which  has  been  used  by 
the  physician  for  many  years  and  yet  its  action  has 
been  questioned. 

Moebius,  a  nerve  specialist  of  great  reputation,  as- 
serted that  four-fifths  of  all  electrical  cures  are  de- 
pendent on  mental  influences.  Beard,  in  his  time,  a 
leader  in  electro-therapeutics,  observed,  "If  you  ex- 
pect to  get  definite  results  from  electrical  applica- 

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Progressive     Spondylotherapy 

tions,  you  must  be  sure  that  your  patient  has  faith, 
otherwise  the  application  will  do  him  no  good." 

Electricity  is  one  of  the  most  valuable  assets  that 
the  physician  possesses  in  the  treatment  of  disease 
when  it  is  used  and  not  abused. 

The  patient  clamors  for  cure  and  is  in  no  wise  con- 
cerned how  it  is  effected. 

The  scientific  physician  clamors  for  proof  concern- 
ing cures  and  rightly  so,  for  all  knowledge  must  be 
arranged  under  general  truths  and  principles.  The 
physician  is  handicapped  in  determining  results  by 
his  lack  of  instruments  of  precision. 

Our  senses  are  gross  and  unreliable.  With  the 
telescope  and  a  photograph  plate  the  presence  of 
millions  of  stars  may  be  revealed  yet  the  light  of 
these  stars  does  not  in  the  least  affect  the  unaided 
eye. 

The  ear  is  deaf  to  most  things  yet  with  a  micro- 
phone the  tread  of  a  fly  is  like  the  march  of  cavalry. 

For  our  heat-sense,  we  need  a  variation  of  one- 
fifth  of  a  degree  on  a  thermometer  to  enable  us  to 
appreciate  any  difference  in  temperature  yet,  with 
the  bolometer  of  Langley,  a  difference  of  a  mil- 
lionth of  a  degree  may  be  detected. 

My  endeavor  in  this  chapter  is  to  show  that  the  var- 
ious forms  of  force  used  in  the  treatment  of  disease 
are  governed  in  their  action  by  one  underlying  prin- 
ciple and  that  the  latter  is  essentially  mechanic.  We 
can  conceive  the  electrons  as  bombarding  space  with 
terrific  speed  thus  giving  rise  to  all  kinds  of  pertur- 
bations of  the  ether. 

When  these  ethereal-waves  impinge  on  a  medium 
of  perception,  they  are  practically  a  series  of  infin- 
itesimal blows  which  act  like  drops  of  water  piercing 
the  rock  not  by  the  force  of  the  blows  but  by  their 
frequency. 

This  conception  of  the  action  of  the  forces  has  sug- 

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Electronotherapy 

gested  to  the  author  the  neologism,  electronotherapy. 

PHYSIOLOGIC  PROOF. — It  is  not  necessary  to  go  far 
afield  to  cite  examples  where  the  reaction  of  an  or- 
ganism is  employed  as  a  test  for  the  action  of  certain 
agents. 

The  physiologic  action  of  currents  was  an  accident- 
al discovery  by  Galvani,  and  since  his  time  many  ex- 
periments have  been  made.  Protoplasm  (also  known 
as  bioplasm),  the  fundamental  basis  of  all  living  bod- 
ies contracts  when  an  electric  current  passes  through 
it. 

Protoplasm  is  made  up  principally  of  water,  oxy- 
gen and  nitrogen  of  the  air  we  breathe  and  from  the 
carbon  of  the  food  we  eat.  To  the  latter  may  be  add- 
ed sulphur,  phosphorus,  iron  and  a  trace  of  mineral 
salts. 

Protoplasm  is  vitally  characterized  by  its  ability  to 
grow,  reproduce  and  to  respond  to  stimuli. 

Nerves  and  muscles  show  a  definite  response  to  the 
action  of  currents. 

Taste-perception  is  produced  when  the  Galvanic 
current  is  applied  to  the  back  of  the  neck;  and  if  the 
same  current  is  passed  through  the  cheek,  the  perci- 
pient can  recognize  the  specific  quality  of  each  pole. 
Passed  through  the  head,  the  same  current  provokes 
a  sensation  of  light  with  color-perception,  and  stimu- 
lation of  the  auditory  nerve  with  the  identical  cur- 
rent, induces  sound  effects. 

It  is  quite  natural  that  nerve-force  should  be  iden- 
tified with  electricity.  The  nervous  system  (and  its 
mechanisms),  has  its  radii  of  lines  with  batteries, 
switches,  relays,  transformers,  condensers,  resist- 
ances, shunts  and  automatic  circuits.  Electricity  is 
known  only  by  its  effects ;  beyond  this  our  knowledge 
does  not  extend. 

We  know  that  electricity  will  decompose  water,  de- 

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Progressive     Spondylotherapy 

fleet  the  needle  of  a  compass  and  heat  a  wire  through 
which  it  flows.  Chemism,  heat  and  light,  the  three 
great  forces  of  Nature,  are  directly  interchangeable 
in  rapidity  and  direction  of  the  molecular  vibrations. 
Chemic  decomposition  produced  by  electricity  is 
known  as  electrolysis  and  the  products  of  such  de- 
composition are  known  as  ions. 

It  is  likely  that  the  atoms  composing  the  living 
animal  tissues  are  merely  ions  which  are  the  material 
carriers  of  electricity. 

Artificial  electric  stimulation  of  nerves  corres- 
ponds most  nearly  to  their  natural  excitation.  Animal 
bodies  create  electrical  currents  and  the  effects  de- 
pend upon  the  nature  of  the  discharge. 

The  feeblest  electric  stimulation  of  a  nerve  induces 
in  it  a  chemical  change.  Thus  nerve-force  is  a  physi- 
cochemic  process.  With  every  contraction  of  muscle 
an  electric  change  occurs. 

The  discharge  of  an  electric  eel  is  sufficient  to  kill  a 
horse  but  the  means  of  producing  this  electric  charge 
is  unknown. 

The  power  of  reacting  to  stimuli,  called  irritability, 
is  the  most  conspicuous  characteristic  of  the  living 
organism. 

The  action  of  etheric-concussion  on  the  living  or- 
ganism has  heretofore  baffled  interpretation  for  the 
reason  that,  no  account  has  been  taken  of  the  reflexes 
of  the  organs. 

Practically  every  organ  of  the  body  has  governing 
centers  in  the  spinal  cord  and  when  these  centers  are 
stimulated  by  the  physiologist  in  his  laboratry,  organs 
can  be  made  to  contract  or  dilate. 

Though  these  results  have  been  partially  attained 
by  vivisection,  it  has  been  shown  by  the  author  that, 
in  the  living  human,  like  effects  may  be  achieved  by 

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Electronotherapy 

the  use  of  stimuli  applied  to  definite  regions  of  the 
spinal  column. 

The  latter  have  been  located  with  reference  to  def- 
inite spines  of  the  vertebrae. 

If,  for  example,  one  strikes  a  series  of  blows  corres- 
ponding to  the  spine  of  the  7th  cervical  vertebra, 
there  is  a  contraction  of  the  heart,  stomach,  liver, 
spleen  and  other  organs. 

The  phenomena  thus  elicited  are  known  as  reflexes. 
Thus  one  speaks  of  a  heart,  stomach,  liver  and  a 
spleen  reflex.  These  reflexes  are  of  some  duration 
but  may  be  dissipated  at  once  by  colored  sheets  of 
gelatine  (blue,  violet  or  red)  held  in  front  of  the  or- 
gan. When  the  latter  maneuver  is  executed,  it  is  im- 
possible to  elicit  the  reflexes  of  the  internal  organs 
for  reasons  cited  on  page  204. 

What  is  known  as  the  knee-jerk,  is  a  forward 
projection  of  the  leg  when  one  taps  the  tendon  be- 
low the  kneecap  with  a  hammer  during  the  time  the 
leg  is  crossed  on  the  knee  of  the  other  extremity. 

When  the  tendon  is  struck,  the  blow  which  is  in 
the  nature  of  a  stimulus  is  conducted  by  a  sensory 
nerve  to  the  spinal  cord.  It  is  then  transmitted  to 
motor-cells  in  the  anterior  part  of  the  cord  where  it 
is  converted  into  an  impulse  which  is  then  con- 
ducted to  the  muscle  resulting  in  contraction  of  the 
latter.  It  is  the  muscular  contraction  which  causes 
the  knee-jerk. 

If  the  toe  of  an  adult  is  pricked  with  a  pin,  the 
foot  is  pulled  away  in  about  one-tenth  of  a  second. 
This  is  also  a  reflex  and  is  very  slow  when  com- 
pared with  the  speed  of  electricity  or  a  light-wave. 
The  latter  would  travel  seven  times  the  equator  in  a 
second  but  the  nerve-wave  travels  at  the  rate  of 
only  100  feet  a  second. 

A  reflex  is  made  up  of  a  stimulus  causing  a  dis- 
charge of  force,  transmission  of  the  latter  to  a  center 
whereby  another  force  is  discharged  and  finally,  the 
transmission  of  force  to  the  stimulated  area. 

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Progressive     Spondylotherapy 

All  actions  are  essentially  reflexes  and  if  this  view- 
point is  carried  further,  it  means  that  we  have  no  will 
of  our  own  and  that  our  actions  are  simply  the  result 
of  external  circumstances.  We  are  instinctively  ac- 
tive like  ants  or  bees  and  we  are  creatures  of  physical 
forces. 

All  reflexes  are  purposeful  in  character.  Thus,  clos- 
ing of  the  eyelid  and  contraction  of  the  pupil  protect 
the  eye  from  foreign  bodies  and  the  retina  from  in- 
tense light. 

Loeb*  contends  that,  irritability  and  conductivity 
are  the  only  qualities  essential  to  reflexes  and  both  are 
common  qualities  of  all  protoplasm  (page  126). 

Plants  possess  no  nerves,  yet  the  flight  of  a  moth 
into  a  flame  differs  in  no  wise  as  a  reflex  or  instinc- 
tive process  from  plant  heliotropism. 

What  happens  to  a  nerve  when  it  is  stimulated 
or  when  it  is  struck  by  a  series  of  blows? 

After  Loeb  demonstrated  that,  muscles  could  be 
made  to  contract  or  relax  under  the  influence  of 
certain  ions,  Mathews  found  that,  a  like  effect 
could  be  observed  in  nerves.  It  was  Graham,  who 
divided  all  substances,  into  those  which  crystalize 
when  they  solidify  and  those  which  do  not. 

The  latter  were  designated  colloids  or  gluelike 
substances.  The  colloids  in  the  body  bear  a  positive 
electrical  charge  and  are  precipitated  by  negative 
ions. 

Now  the  nerves  consist  of  colloid  particles  in 
suspension  and  the  thicker  this  jelly-like  substance, 
the  better  will  the  nerve  conduct.  When  chloro- 
form or  ether  is  inhaled  unconsciousness  ensues 
when  the  nerves  no  longer  conduct  sensation.  Here, 
the  action  of  the  anesthetic  is  to  dissolve  the  colloid 
substance  and  the  thinner  the  latter  the  less  easily 
will  the  nerves  conduct. 

The  colloid  particles  as  intimated  are  positively 
charged  and  a  nerve  is  stimulated  by  a  current 
proceeding  from  the  negative  pole.  The  positive 

*The   Mechanistic    Conception    of    Life,    1912. 

122 


ectronotherapy 


and  negative  ions  in  a  nerve  are  balanced.  Now 
suppose  the  nerve  is  stimulated  by  blows,  then  the 
colloid  particles  coming  together  would  have  their 
surfaces  reduced.  The  latter  would  reduce  their 
electrical  charge  and  releasing  a  number  of  neg- 
ative charges,  a  nerve  impulse  would  be  started. 

SPINAL  CONCUSSION. — If  the  7th  cervical  vertebra 
corresponding  to  3  in  Fig.  19,  is  struck  a  series  of 
blows  with  a  rubber-hammer,  the  nerve-roots  are 
stimulated  and  the  blows  are  propagated  to  the  vagus 
or  pneumogastric  nerve. 

When  the  latter  nerve  is  thus  stimulated  indirectly, 
there  is  a  contraction  of  the  organs  (heart,  liver, 
spleen  and  stomach).  Such  contraction  may  be  read- 
ily observed  when  the  patient  is  before  the  X-rays 
and  it  can  be  demonstrated  by  percussion. 

If  the  blows  are  feeble,  there  is  no  contraction  of 
the  organs,  but  instead  a  stimulation  of  the  vagus. 
Stimulation  of  the  latter  is  characterized  by  an  in- 
crease of  tone.  What  is  known  as  "  TONE"  will  be  de- 
scribed presently.  Visceral-tone  has  also  been  dis- 
cussed on  page  7. 

The  vagus  is  the  longest  and  most  extensively 
distributed  cranial  nerve.  How  do  we  know  that  it 
is  through  the  vagus  that  blows  delivered  at  the  7th 
cervical  vertebra  contract  the  organs? 

It  atropin  is  injected  into  the  body  before  an  at- 
tempt is  made  to  elicit  the  reflex  contraction  of  the 
organs,  the  latter  cannot  be  evoked.  This  is  because 
atropin  paralyzes  the  motor  endings  of  the  vagus. 
After  several  hours,  the  paralyzing  effects  of 
atropin  evanesce  when  it  is  again  possible  to  con- 
tract the  organs  by  blows  delivered  at  the  identical 
vertebra. 

PERCUSSION  OF  THE  STOMACH. — The  stomach  re- 
ceives its  motor  supply  from  the  vagus,  i.  e.,  if  the  lat- 
ter nerve  is  stimulated,  the  muscular  fibers  of  the  or- 

123 


Progressive     Spondylotherapy 

gan  contract,  in  other  words,  the  tone  of  the  organ  is 
increased. 

Now,  tone  is  .an  essential  attribute  of  all  living  or- 
ganisms. For  all  practical  purposes,  the  term  relaxa- 
tion, may  be  used  as  the  antithesis  of  tone. 

The  centers  in  the  brain  and  spinal  cord  are  in  a 
state  of  tonic  excitation  and  from  these  centers  im- 
pulses are  constantly  passing  through  nerves  to 
muscles  and  organs  maintaining  the  latter  in  a  con- 
dition of  tonic  stimulation. 

If  a  decapitated  frog  is  suspended  vertically  with 
the  hind  legs  downward  and  the  sciatic  nerve  of  one 
leg  is  severed,  this  leg  will  hang  down  more  limply 
than  the  other  leg.  Such  an  experiment  shows  that 
the  tonic-impulses  are  no  longer  conveyed  from  the 
spinal  cord  to  the  muscles  supplied  by  the  severed 
nerve. 

If  percussion  of  the  stomach  is  attempted  on  an  in- 
dividual (standing),  one  elicits  a  tympanitic  sound 
but  if  the  vagus  is  stimulated  (by  striking  the  7th 
cervical  vertebra),  a  dull  sound  is  provoked.  In  our 
investigations  we  have  determined  the  potentiality  of 
the  forces  in  three  ways : 

1     By  the  intensity  of  the  dullness. 

2.  By  the  duration  of  the  dullness. 

3.  By  the  distance  at  which  the  force  is  operative. 

A  moderately  thin  subject  should  be  selected 
for  experimentation  and  percussion  must  be  exe- 
cuted with  the  subject  in  the  erect  posture.  If  the 
blows  are  forcible,  in  association  with  the  dull- 
ness, there  is  a  contraction  of  the  organ,  otherwise 
only  dullness  without  any  retraction  of  the  organ. 

Why  does  stimulation  of  the  vagus  convert  a  tym- 
panitic into  a  dull  sound?  Such  stimulation  causes 
the  walls  of  the  stomach  to  become  tense  (owing  to  in- 
creased tone  of  the  muscle-fibers  in  the  organ),  thus 

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Electronotherapy 

putting  the  air  or  gas  in  the  stomach  under  increased 
tension.  For  the  latter  reason,  we  have  the  physical 
elements  necessary  for  the  transition  of  a  tympanitic 
to  a  dull  sound. 

Naturally,  the  amplitude  and  length  of  the  waves 
set  up  in  the  ether  when  light,  electrical  energy  or 
magnetic  disturbances  are  distributed  will  influence 
the  results. 

To  test  the  action  of  the  forces,  I  employed  a  strip 
of  metal.  In  the  latter,  a  small  opening  was  made 
which  was  applied  over  the  7th  cervical  vertebra.  It 
is  necessary  to  protect  the  other  regions  of  the  spine 
to  eliminate  the  action  on  other  centers. 

When  light  (used  at  a  distance  to  eliminate  the 
heat  factor),  heat,  electricity  (sinusoidal),  radium, 
or  electromagnetic  waves  were  applied  over  the  spin- 
ous  process  in  question,  the  effect  was  always  the 
same,  vis.,  dullness  of  tlie  stomach  on  percussion.  The 
moment  some  of  these  forces  were  removed,  the  tym- 
panitic tone  of  the  stomach  was  restored.  In  other 
words,  the  action  of  some  of  the  forces  was  purely 
transitory. 

The  electromagnetic  waves  from  a  parabolic  reflec- 
tor were  effective  at  a  distance  of  several  feet. 

Radium  (10  milligrams  used),  was  only  effective 
when  it  was  held  in  juxtaposition  to  the  vertebra  but 
the  moment  it  was  removed,  the  stomach-dullness  dis- 
appeared. In  fact,  radium  was  the  most  transitory 
in  its  effects. 

The  X-rays  were  effective  for  a  brief  period  after 
their  action.  I  always  attributed  shrinking  of  the 
heart  during  exposure  to  the  Roentgen  rays  as  psy- 
chic in  origin.  In  other  words,  the  contraction  of  the 
organ  was  attributed  to  emotional  causes.  This  view 
demands  revision  in  accordance  with  these  later  ob- 
servations. 

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Progressive     Spondylotherapy 

The  most  powerful  of  all  the  forces  in  its  duration 
was  the  magnetic  force  and  the  latter,  will  be  the  sub- 
ject of  consideration  in  future  chapters. 

LIVING  BIOPLASM. — All  living  bioplasm  is  distin- 
guished and  characterized  by  the  following  proper- 
ties: 

1.  Irritability,  or  the  power  to  react  in  a  definite 
manner  to  some  form  of  external  excitation  irrespec- 
tive of  the  fact  whether  the  stimulus  is  electric,  me- 
chanic or  chemic.  If  the  bioplasm  is  represented  by 
muscle,  the  reaction  is  a  contraction  of  the  muscle. 

2.  Conductivity,  or  the  ability  to  transmit  mole- 
cular disturbances  at  one  point  to  all  parts  of  the  ir- 
ritable material. 

3.  Motility,  or  the  power  of  exhibiting  spontan- 
eous movements. . 

Physiologists  aver  that,  all  protoplasmic  move- 
ment is  the  resultant  of  natural  causes  the  nature  of 
which  is  not  understood. 

We  shall  attempt  to  prove  that  the  foregoing 
properties  of  bioplasm,  which,  in  their  summation  is 
nought  else  but  tone,  may  be  reproduced  by  magnetic 
force  without  stimuli  transmitted  from  the  nerve- 
centers. 

Furthermore,  that  in  such  reproduction  the  tone 
exceeds  that  created  in  the  organism. 

Summarizing  the  subject-matter  of  this  chapter, 
the  following  conclusions  may  be  formulated. 

1.  The  therapeutic  action  of  the  various  forms  of 
force  is  dependent  upon  matter  in  motion. 

2.  The  etheric-waves  thus  created  by  bombarding 
electrons  are  equivalent  in  their  action  to  a  species  of 
concussion. 

3.  Insomuch  as  the  action  of  all  the  forces  is  gov- 
erned by  one  underlying  principle  which  is  essentially 

126 


Elect   ronotherapy 

mechanic,  the  neologism  electronotherapy  is  suggest- 
ed. 

4.  In  electronotherapy,  reflexes  are  elicited  inde- 
pendent of  the  fact  whether  the  forces  are  employed 
at  the  periphery  or  at  a  spinal  center.    Applied  in  the 
latter  situation,  the  reflexes  are  of  greater  amplitude 
and  of  longer  duration.  It  is  therefore  evident  in  the 
treatment  of  disease  by  aid  of  reflexes  (Reflexother- 
apy ) ,  the  elicitation  of  central  reflexes  is  preferable. 

5.  The  forces  like  light  and  the  X-rays,  directed 
toward  the  stomach-region  and  at  a  distance,  will  in- 
crease the  tone  of  the  stomach,  as  evidenced  by  the 
conversion  of  the  normal  tympanitic  sound  into  a  dull 
one. 

The  moment  the  forces  cited  are  brought  in  imme- 
diate contact  with  the  stomach-region  their  irritant 
effect  becomes  manifest  and  no  dullness  ensues. 

Light  from  the  thermotherapeutic  lamp  which  con- 
sists of  a  large  incandescent  bulb  (50  C.  P.),  in  con- 
nection with  a  parabolic  metallic  reflector,  yields  a 
stomach-dullness  at  a  distance  of  24  feet  after  pass- 
ing through  two  plaster-walls  of  my  office. 

With  a  patient  within  a  few  feet  from  the  source 
of  illumination,  the  rays  pass  through  lead,  sheet-iron 
and  other  metal.  In  other  words,  if  a  sheet  of  metal 
is  held  over  the  stomach  and  the  light  is  directed  on 
the  metal,  a  dullness  of  the  stomach  can  be  elicited. 
This  dullness  however  evanesces  the  moment  the  light 
is  withdrawn. 

This  experiment  demonstrates  that  there  are  com- 
ponents in  light  which  in  their  penetrative  power  bear 
a  resemblance  to  Roentgen's  rays  but  differing  from 
the  latter,  in  their  ability  to  pass  through  glass,  lead 
and  bone. 

The  great  mathematician,  James  Clerk-Maxwell, 
contended   that   light   and   electricity   were    funda- 

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Progressive     Spondylotherapy 

mentally  one.  It  was  on  this  theory  that  Hertz,  was 
led  to  discover  his  waves  which  Marconi,  utilized 
for  conveying  messages.  Sir  Oliver  Lodge,  refers 
to  light  as  an  electro-magnetic  disturbance  of  the 
ether.  In  other  words,  light  is  an  electric  vibration, 
the  result  of  electric  oscillitions  in  the  molecules 
of  bodies  which  are  hot  or  in  bodies  without  heat 
(phenomenon  of  phosphorescence). 

Further  experiments  were  conducted  with  an  or- 
dinary 16  C.  P.  incandescent  bulb ;  the  subject  stand- 
ing at  a  distance  of  5  feet  from  the  source  of  illumina- 
tion. The  transition  of  the  stomach  from  tympanicity 
to  dullness  being  utilized  as  a  criterion  of  action. 

The  following  conclusions  were  formulated  with 
reference  to  several  investigations : 

1.  An  uncolored  bulb  produced  dullness  only  dur- 
ing the  time  the  light  was  directed  on  the  stomach- 
region. 

2.  Filtered  through  blue  or  red  glass,  the  results 
were  absolutely  negative,  i.  e.,  no  dullness  ensued.  The 
results  were  equally  negative  with  green  and  violet. 

3.  Filtered  through  yellow  glass,  a  dullness  (after 
removal  of  the  light)  ensued  lasting  2  minutes.    In 
this,  as  well  as  in  the  foregoing  experiments,  the  ex- 
posure was  about  20  seconds  in  duration. 

4.  The  solar  rays*  were  negative  until  concentrat- 
ed by  aid  of  a  large  lens  at  some  distance.    Too  small 
a  focus  annihilated  the  results.  When  the  solar  rays 
were  focused  on  a  sheet  of  lead  held  in  front  of  the 
stomach-region,  dullness  of  the  stomach  ensued  just 
the  same  as  when  light  from  an  incandescent  bulb  was 
passed  through  a  sheet  of  lead. 

*Kime  (Iowa  Med.  Jour.,  April,  1900),  speaking  of  his  own  work  on 
the  use  of  the  solar  rays  (heliotherapy),  refers  to  Finsen,  himself  and 
myself,  who  working  along  the  same  lines  independently,  each  has  pur- 
sued his  own  methods.  "In  order  of  their  publication,"  he  continues,  "the 
papers  were,  Abrams,  March,  1899;  Kime,  June,  1899;  Finsen,  September, 
1899." 

The  treatment  of  laryngeal  tuberculosis  by  the  solar  rays  is  accredit- 
ed to  Sorgo,  and  called  the  "Sorgo  Treatment."  The  identical  method  was 
suggested  by  the  author  many  years  in  advance.  The  only  reasonable  ob- 
ject of  this  citation,  is  to  establish  the  matter  of  priority  in  discovery. 

128 


Electronotherapy 

5.  When  the  magnetic  flux  from  a  small  or  a  pow- 
erful electromagnet  passed  through  any  colored  glass 
excepting  yellow  glass,  no  stomach  dullness  ensued. 

6.  When  the  magnetic  flux  passes  through  a  yel- 
low medium,  the  stomach  tonicity  (as  revealed  by 
dullness),  lasts  nine  times  as  long  as  simple  exposure. 
Gamboge  painted  over  the  stomach-region  prolongs 
the  tonicity  three  times  the  length  of  time. 

Crude  experiments  conducted  by  the  author  show 
that,  color  modifies  the  attractive  attributes  of  an 
ordinary  magnet;  yellow  and  blue  increasing  and 
red,  decreasing  such  attraction. 

7.  Heat  is  negative  through  colored  glass  except- 
ing yellow. 

8.  When  a  concussion-apparatus  is  allowed  to  con- 
cuss the  air  at  some  distance  from  the  subject,  stom- 
ach-dullness may  be  elicited.    If  colored  media  are  in- 
terposed between  the  apparatus  and  the  subject,  no 
dullness  ensues  unless  yellow  glass  or  a  yellow  gela- 
tine sheet  is  used. 

9.  A  yellow  medium  prolongs  the  duration  of  the 
stomach-tonicity  with  heat,  light  and  magnetism  to  a 
greater  extent  than  when  the  latter  are  used  alone. 

10.  When  two  forces  are  employed  synchronously 
no  stomach-dullness  ensues ;  one  force  negativing  the 
action  of  the  other  force. 

Here,  we  are  probably  dealing  with  similarly 
charged  forces  as  is  the  case  with  colors  (page  204). 
If  heat  and  light  are  used  simultaneously  with  the 
magnetic  force  so  that,  the  heat  or  light  is  directed 
toward  the  negative  pole  of  the  magnet  (while  the 
positive  pole  of  the  latter  is  directed  toward  the 
body),  stomach-dullness  ensues. 

11.  When  yellow  glass  is  placed  in  front  of  an 
X-ray  tube  some  rays  pass  which  produce,  a  stomach- 
dullness. 

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Progressive     Spondylotherapy 

12.  If  yellow  glass  is  held  in  front  of  the  stomach 
in  ordinary  light,  a  dullness  at  once  ensues.  This  color 
will  intensify  the  tone  of  all  the  organs  and  permits  of 
a  better  definition  of  their  boundaries  by  percussion. 
In  other  words,  this  color  augments  the  tonicity  of  the 
organs.    Other  colors  thus  used  diminish  the,  tonicity 
and  decrease  the  boundaries  of  the  organs   (page 
151).    To  relax  the  organs  and  thus  secure  a  visceral 
rest-cure,  green,  violet  or  blue  may  be  used  and  yellow 
when  a  tonic  effect  is  desired. 

13.  Any  variation  in  the  proportion  and  charact- 
er of  the  electrolytes  in  a  tissue  is  capable  of  impart- 
ing to  that  tissue  certain  properties.    The  chief  elec- 
trolyte in  our  blood  is  sodium  chlorid.    If  a  muscle  is 
put  into  a  solution  of  the  latter  (i.  e.,  isotonic  with  the 
muscle),  it  twitches  rhythmically,  while  the  addition 
of  a  soluble  calcium  salt  prevents  the  twitching.  My 
investigations  show  that  the  stomach-musculature  ex- 
hibits like  phenomena.    Let  a  subject  ingest  50Cc.  of 
normal  salt  solution — a  persistent  stomach-dullness 
ensues  until  inhibited  by  the  ingestion  of  the  same 
quantity  of  fluid  containing  5  grains  of  chlorid  of  cal- 
cium.   When  the  latter  is  ingested,  it  is  impossible  to 
impart  tone  to  the  stomach  by  the  most  powerful  mag- 
netic flux.  Chlorid  of  calcium  may  be  indicated  in  all 
spasmodic  conditions  of  the  stomach-muscle. 


130 


Magnetic          Fo 


CHAPTER  VII. 

MAGNETIC  FORCE 
HISTORICAL. 

MAGNETISM    AND    CHARLATANRY— GILBERT— PARACELSUS— MES- 
MER— DE  PUYSEGUR— PERKINS — MODERN  HISTORY. 

We  are  devoting  special  consideration  to  the  mag- 
netic force  for  the  reason  that,  it  is  convenient  to  use, 
it  has  no  pernicious  effects,  it  is  more  potential  in 
action  and  it  has  antedated  the  various  forms  of 
force  in  the  treatment  of  disease. 

The  force  of  magnetism  can  lay  claim  to  great  an- 
tiquity. It  is  not  strange  that,  "The  Father  of  Phil- 
osophy," Thales,  should  have  endowed  the  magnet 
with  a  soul  or  as  an  expression  of  life.  If  this  mys- 
terious force  were  unknown  to  us,  even  in  this  day  of 
great  achievements,  its  discovery  would  awaken  the 
same  extraordinary  interest  and  awe  which  Plato, 
Aristotle  and  even  Homer  could  not  evade. 

If  Lucretius,  were  inspired  to  sing  the  magnet's 
power  in  his  "De  Rerum  Natura,"  he  could  have 
apostrophized  no  greater  marvel. 

The  fact  that,  we  are  already  acquainted  with  some 
of  its  attributes,  should  prove  an  incentive  to  know 
more  about  a  force  the  nature  of  which  is  only  known 
to  us  by  its  effects.*  The  medical  history  of  mag- 
netism is  a  riotous  recital  of  misguided  judgment, 
defective  imagination  and  charlatanry. 

Contributory  to  exaggeration  of  statement  was  the 

•"It  is  sometimes  of  great  use  in  natural  philosophy,"  said  Sir  Wil- 
liam Herschel,  to  doubt  of  things  that  are  commonly  taken  for  granted, 
especially  as  the  means  of  resolving  any  doubt,  when  once  it  is  enter- 
tained, are  often  within  our  reach." 

131 


Progressive     Spondylo  therapy 

fact  that,  no  attribute  however  mysterious  could  be 
superimposed  on  the  magnetic  force  which  could  add 
to  its  mysteriousness. 

So  securely  is  magnetism  interwoven  with  char- 
latanry that,  he  who  attempts  to  sever  the  bonds 
must  be  prepared  to  suffer  the  darts  of  calumny 
but  the  undaunted  one,  will  find  ample  reward  for 
his  undertaking  despite  the  fact  that,  in  medicine, 
it  is  easier  to  establish  a  fact  than  to  have  it  ac- 
cepted. 

Perhaps  the  greatest  work  ever  published  on  mag- 
netism was  that  of  an  Englishman,  William  Gilbert, 
who,  in  the  year  1600,  was  President  of  the  "Royal 
College  of  Physicians."  He  mentions  that, 
Discorides,  believed  that  if  a  piece  of  lodestone,  were 
finely  ground  and  mixed  with  water  it  would  when 
swallowed,  benefit  many  disorders  of  the  blood. 

Magnetic  medicine  however,  was  regarded  as  dan- 
gerous, insomuch  as  it  contributed  to  melancholia  and 
even  death.  The  ancients  who  entertained  curious 
ideas  respecting  the  curative  virtues  of  magnets 
conceived  different  kinds,  some  of  which  \vere  bene- 
ficial and  others  dangerous. 

Some  asserted  that  small  quantities  of  ground 
lodestone  were  the  true  "elixir  of  life."  It  was  also 
claimed  that,  lodestone  taken  internally,  possessed 
the  power  of  drawing  iron  arrow-heads  from  the  body 
and  that,  this  power  was  also  effective  in  absorbing 
the  arrow-head. 

The  famous  salve  of  Paracelsus,  for  the  treatment 
of  wounds  caused  by  iron-daggers  was  an  elaboration 
of  this  idea.  The  salve  was  essentially  a  compound 
of  powdered  lodestone  and  ordinary  ointment. 

It  was  this  same  Paracelsus,  really  a  great 
physician,  in  the  first  half  of  the  16th  century,  who 
regarded  personal  magnetism  as  a  force  not  unlike 
that  of  a  magnet  which  attracted  iron. 

132 


Magnetic          Force 

To  him  the  attraction  of  sex  was  essentially 
magnetic. 

What  we  now  call  gravitation,  was  regarded  by 
Kepler,  perhaps  the  most  profound  thinker  of  his 
time,  as  magnetic  attraction.  To  him,  the  magnet 
was  the  soul  of  the  physical  world  and  it  was  by 
magnetic  attraction  that  the  planets  were  held  in 
bondage  with  the  sun. 

Descartes,  was  likewise  engaged  with  a  theoretical 
study  of  magnetism. 

At  this  epoch,  the  magneto-motive  force  was  em- 
ployed as  a  convenient  vehicle  for  explaining  all 
psychologic  phenomena  and  it  was  extensively  used 
in  the  treatment  of  disease. 

In  1766,  Mesmer,  published  "De  Planetarum 
Influxu,"  designed  to  show  planetary  influence  on  the 
nervous  system  and  his  "Ueber  die  Magnetkur"  was 
the  product  of  his  studies  of  magnetism  as  a  curative 
agent. 

Mesmer,  supposed  that  a  force  existed  which  he 
called  "animal  magnetism,"  by  means  of  which,  one 
person  could  influence  another.  This  "  animal  in- 
fluence," he  regarded  as  the  essential  nature  of  mes- 
merism. Subsequent  investigators  demonstrated 
conclusively  •  that,  the  phenomena  observed  by 
Mesmer,  were  wholly  subjective  and  quite  inde- 
pendent of  any  known  force. 

Swedenborg,  in  1763,  claimed  that,  by  magnetic 
sleep  one  could  be  raised  to  the  celestial  light  even 
in  this  world,  if  the  bodily  senses  could  be  entombed 
in  lethargic  slumber. 

Binet  and  Fere,  describe  the  performances  of 
Mesmer,  who,  with  a  long  iron-wand  would  walk 
among  his  throng  of  patients  touching  the  latter 
particularly  the  affected  parts  of  the  body.  To 
energize  his  results,  he  would  sometimes  substitute 
for  his  manipulations  strong  electric  currents.  In 

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Progressive     Spondylotherapy 

his  manipulations,  he  would  pass  his  fingers  over 
the  body  of  the  patient  time  and  time  again,  until 
he  was  assured  that  the  magnetized  person  was 
thoroughly  saturated  with  the  healing  fluid. 

De  Puysegur,  in  his  instructions  to  hypnotizers, 
whom  he  designates  as  magnetizers,  enjoins  them 
to  regard  themselves  as  magnets  and  the  arms,  par- 
ticularly the  hands,  as  poles  and  to  imagine  the 
magnetic  fluid  as  passing  from  one  hand  to  the  other 
through  the  body  of  the  patient. 

An  American,  Dr.  Elisha  Perkins,  by  name,  may 
be  regarded  as  the  prince  of  charlatans.  He  ex- 
ploited the  discoveries  of  Galvani  and  Volta,  by  em- 
ploying two  pieces  of  metal  known  as  "Metallic 
Tractors."  The  latter  drawn  over  affected  parts 
could  cure  practically  everything  by  virtue  of  their 
magnetic  influence.  His  patented  discovery  gained 
him  wealth  and  fame.  The  "tractor  cure,"  as  it  was 
called,  led  Dr.  Haygarth,  to  fabricate  a  pair  of  false 
tractors  by  which  marvelous  magnetic  cures  were 
likewise  effected.  These  tractors  were  made  of  every 
conceivable  material  but  results  were  equally  good, 
provided  the  operator  during  their  application,  dis- 
cussed magnetism  and  described  squares,  circles  and 
triangles  with  the  sham-tractors. 

In  New  York,  at  one  time,  yellow  fever  was  preva- 
lent and  Perkins,  with  faith  in  his  tractors  went 
there  to  cure  the  disease  but  succumbed  to  the  fever 
which  he  contracted. 

Belief  in  the  curative  powers  of  the  magnet  was 
promulgated  by  Baron  von  Reichenbach.  He  claimed 
to  have  discovered  a  new  force  from  magnets  which 
he  called  odic  or  odylic  force.  The  latter,  like  the 
magnetic  flux,  was  invisible  and  its  properties  could 
only  be  determined  by  its  effects.  Despite  the  popu- 
larity of  the  odic  force  in  the  treatment  of  disease, 

134 


Magnetic          Force 

it  was  shown  that  the  effects  were  caused  by  the 
influence  of  the  mind  over  the  body.  Though  the 
patients  claimed  they  could  see  faint  luminous 
emanations  issuing  from  the  magnet,  a  piece  of  wood 
so  prepared  to  resemble  a  magnet  yielded  like  results. 

MODERN  HISTORY. — The  concensus  of  opinion  of 
modern  investigators  favors  the  view  that,  magnets 
are  endowed  with  absolutely  no  power  on  the  human 
organism  and  that,  so-called  magneto-therapy  is 
merely  a  delusion. 

Some  years  ago,  Thomas  Edison,  confined  a  boy's 
head  inside  a  colossal  electro-magnet  thus  permitting 
the  magnetic  flux  to  pass  through  his  brain.  Abso- 
lutely no  effects  were  observed.  Later,  experiments 
were  made  with  the  flux  passing  through  the  body  of  a 
man.  The  flux  was  sufficiently  powerful  to  hold  rig- 
idly heavy  iron-spikes  against  the  breast  and  fore- 
head, yet  no  effects  either  for  weal  or  woe  were  noted. 

As  a  result  of  elaborate  experiments  made  by 
Peterson12  and  Kennelly,  they  concluded  that,  the 
human  organism  was  in  no  wise  appreciably  affected 
by  the  most  powerful  magnets  and  that,  neither  direct 
nor  reversed  magnetism  exerts  any  apparent  in- 
fluence upon  the  iron  contained  in  the  blood,  upon 
the  circulation,  upon  the  brain,  nerves  or  upon  ciliary 
or  protoplasmic  movements. 

Modern  literature  is  quite  prolific  with  the  reports 
of  cases  cured  by  "magnetic  wave-currents,"  and  one 
physician,  who  reports  many  such  cases,  concludes, 
"  results  are  so  much  more  satisfying  and  convincing 
than  a  library  of  theories." 

To  account  for  these  results  many  ingenious 
theories  are  invoked.  One  supposes  that  the  magnetic 
waves  have  a  vibratory  action  upon  cellular  life. 
Another,  compares  the  action  of  the  waves  to  the 
exchange  between  the  poles  of  a  Galvanic  current. 

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Progressive     Spondylotherapy 

Another,  is  convinced  that,  by  permitting  the  waves 
to  act  promiscuously  along  the  spine,  there  is  a  not- 
able effect  on  metabolism.  Wm.  Harvey  King,  con- 
ducting a  series  of  experiments  with  the  waves  on 
blood-pressure,  noted  an  average  increase  of  the  latter 
of  16  mm.  He  found  that,  the  treatment  increased 
the  out-put  of  urea  and  uric  acid  with  a  perceptible 
increase  of  indican.  Investigations  with  these  waves 
on  the  blood  demonstrated  an  increase  of  hemoglobin, 
leucocytes  and  red  blood-corpuscles.  Unfortunately, 
the  foregoing  observations  cannot  be  accepted  as 
evidence  of  the  action  of  magnetic  waves  insomuch  as 
the  sinusoidal  current  taken  from  the  magnetic  poles 
was  also  employed. 

A  very  pertinent  fact  however,  illuminates  these 
observations  of  King13.  Referring  to  the  treatment 
of  constipation,  he  says,  "I  have  been  obliged  at  first 
to  use  the  sinusoidal  current  as  taken  from  this 
machine  until  there  is  established  a  more  or  less 
regular  movement  of  the  bowels.  When  this  is  accom- 
plished, the  patient  is  again  placed  in  the  regular 
magnetic  field,  with  a  result  of  continued  improve- 
ment so  far  as  regularity  of  movement  is  concerned 
and  in  general  improvement. ' '  The  insignificance  of 
the  foregoing  will  become  apparent  by  reading  the 
subsequent  chapter. 

Magnets  are  now  used  for  removing  foreign  bodies 
(iron  and  steel)  from  the  eye  in  a  simple  and  efficient 
manner.  The  electro-magnet  is  equally  efficient  in 
diagnosis.  Definite  sensations  of  pain  in  the  eye 
when  the  circuit  of  the  electro-magnet  is  made  or 
broken,  suggests  the  presence  of  magnetic  metal. 

The  sideroscope,  a  magnetic  needle  suspended  upon 
a  silk  thread,  will  also  assist  in  the  detection  of 
foreign  bodies  in  the  eye.  Sellheim14,  after  introduc- 
ing a  soft-iron  catheter  inside  the  uterus  studied  the 

136 


Magnetic          Force 

movements  of  the  latter  under  the  influence  of  a 
powerful  magnet  applied  outside.  The  force  was 
sufficient  to  straighten  a  retroflexed  uterus.  The 
alternate  lifting  and  dropping  of  the  uterus  was 
utilized  as  a  species  of  massage  and  by  mobilizing  the 
organ,  adhesions  from  inflammations  were  prevented. 


137 


Progressive     Spondy  1  o  th  er  apy 


CHAPTER  VIII. 

MAGNETIC  FORCE 
BHYSICS. 

MAGNETK!  POLES — MAGNETIC  FORCE — MAGNETIC  MATERIALS — 
DIAMAGNETISM— DEMAGNETIZATION  —  THEORIES  —  MAGNETIC 
FIELD— MECHANICAL  EFFECTS— TERRESTRIAL  MAGNETISM. 

Only  relevant  data  concerning  this  subject  will 
be  briefly  discussed. 

MAGNETIC  POLES. — The  north  pole  of  the  magnet,  is 
also  called  the  positive  or  plus  (  -f- )  pole  and  the  south 
pole,  is  also  known  as  the  negative  or  minus  ( — )  pole. 

One  of  the  fundamental  laws  is  that :  Like  magnetic 
poles  repel  one  another  and  unlike  poles  attract  one 
another.  This  is  similar  to  the  law  of  attractions 
and  repulsions  of  electric  charges.  The  two  poles  are 
inseparable,  *.  e.,  a  magnet  with  only  one  pole  is 
impossible. 

MAGNETIC  FORCE. — Force  is  that  which  moves  or 
tends  to  move  matter.  The  force  which  a  magnet 
attracts  or  repels  another  magnet  or  magnetic 
material  is  known  as  magnetic  force. 

The  force  exerted  between  two  magnetic  poles  is 
proportional  to  the  product  of  their  strengths  and  is 
inversely  proportional  to  the  square  of  the  distance 
between  them. 

MAGNETIC  AND  NON-MAGNETIC  MATERIALS. — Any 
substance  in  which  magnetism  may  be  induced  and 
which  is  therefore  attracted  by  a  magnet  is  known 
as  magnetic  material.  The  following  are  recognized 
as  magnetic:  iron  (the  strongest  known  magnetic 
material),  steel,  nickel  and  cobalt.  Salts  of  iron  and 

138 


Physics      of      Magnetic      Force 

other  metals,  porcelain,  paper  and  oxygen  are  feebly 
attracted  by  a  powerful  magnet.  Materials  which  are 
neutral  as  regards  magnetism  are  referred  to  as  non- 
magnetic. 

DIAMAGNETISM. — Diamagnetic  bodies  refer  to  sub- 
stances (bismuth,  antimony,  phosphorus,  copper) 
which  are  apparently  repelled  from  the  poles  of  a 
magnet. 

INDUCED  MAGNETISM. — If  magnetism  is  communi- 
cated to  a  magnetic  material  without  actual  contact, 
the  substance  is  said  to  be  magnetized  by  induction. 
Induction  takes  place  along  certain  directions  known 
as  lines  of  magnetic  induction  or  lines  of  magnetic 
force.  The  latter  act  through  a  vacuum  and  air  and 
through  all  materials  excepting  those  in  which  mag- 
netism may  be  induced.  Magnetism  set  up  by  an 
electric  current  is  known  as  electromagnetism. 

DEMAGNETIZATION. — If  a  magnet  is  struck  by  a 
series  of  blows  or  heated  to  a  temperature  about  red 
heat,  for  unknown  reasons,  the  greater  part  of  its 
magnetism  disappears. 

According  to  Bidwell,  light  falling  upon  a  recently 
demagnetized  iron  produces  an  immediate  revival  of 
magnetism. 

COERCIVE  FORCE. — Some  materials  are  more  easily 
magnetized  and  demagnetized  than  others.  In  such 
instances  it  is  assumed  that,  there  is  some  force 
known  as  coercive  force  or  retentivity,  opposing 
magnetization  and  demagnetization. 

SATURATION. — A  magnet  when  fully  magnetized  is 
said  to  be  saturated.  When  the  latter  has  been 
attained,  it  grows  weaker  for  a  definite  time  and  if 
left  alone,  the  magnetism  finally  becomes  permanent 
in  strength. 

THEORY  OF  MAGNETISM. — Magnetism  is  not  a  fluid. 
When  a  magnet  magnetizes  steel  it  loses  none  of  its 


Progressive     Spondylotherapy 

own  magnetism.  A  fluid  is  incapable  of  propagating 
itself  indefinitely  without  loss.  The  theory  now  ac- 
cepted is  that,  molecules  of  magnetic  material  are 
magnets  by  nature  and  when  unmagnetized,  the 
molecules  are  arranged  in  a  haphazard  manner  so 
that  they  neutralize  each  other's  external  magnetic 
effects.  If  this  material  is  now  subjected  to  the  in- 
fluence of  magnetic  force,  the  molecules  become  so 
arranged  that  their  poles  point  in  the  same  direction 

(Fig:  31). 

MAGNETIC  FIELD. — The  space  surrounding  a  magnet 
pervaded  by  the  magnetic  forces  is  known  as  the 
magnetic  field  and  is  most  intense  near  the  poles  of 
the  magnet. 


FIG.  31. — Illustrating  the  theory  of  magnetism.  In  the  upper  figure 
the  molecules  owing  to  their  disorderly  arrangement  have  lost  their  mag- 
netism but  when  the  molecules  are  arranged  end  to  end,  so  that  the  N- 
seeking  poles  all  point  in  one  direction  and  the  S-seeking  poles  in  the 
other  as  in  the  lower  figure,  the  molecules  are  magnetized. 

MECHANICAL  EFFECTS  OF  MAGNETIZATION. — When 
an  iron  bar  is  strongly  magnetized  it  increases  by 
1  /  720000  of  its  length,  and  when  the  magnetizing 
force  is  stronger,  it  again  contracts.  The  increment  in 
length  is  due  to  the  molecules  setting  themselves  with 
their  longest  directions  parallel  to  the  length  of  the 
bar  (Fig  31).  Nickel  contracts  slightly  when  mag- 
netized. When  a  bar  is  magnetized  or  de-magnetized, 
a  faint  metallic  click  in  the  bar  is  heard. 

These  observations  prove  that  in  magnetization 
there  is  a  disturbance  in  the  arrangement  of  the 
molecules.  In  what  is  known  as  the  magnetization  of 

HO 


Physics      of      Magnetic      Force 

light,  it  has  been  found  that  a  ray  of  polarized  light 
passing  through  certain  substances  in  a  magnetic 
field  has  the  direction  of  its  vibrations  changed. 

TERRESTRIAL  MAGNETISM. — The  earth  is  a  powerful 
magnet  and  has  its  magnetic  poles.  From  the  earth's 
north  magnetic  pole  in  the  Southern  Hemisphere,  a 
huge  stream  of  magnetic  flux  is  constantly  flowing 
through  the  atmosphere  until  it  reaches  the  earth's 
south  magnetic  pole  in  the  Northern  Hemisphere. 
These  magnetic  streamings  pass  along  paths  of  least 
resistance.  The  presence  of  magnetic  oxides  of  iron 
and  masses  of  iron  or  steel  facilitates  their  passage. 
Thus,  the  flux-streams  are  concentrated  around 
structural  steel  buildings  and  railroad  tracks.  . 

A  compass  needle  so  suspended  as  to  be  able  to 
move  either  in  a  vertical  or  horizontal  plane  inclines 
or  dips  toward  the  earth.  There  is  no  dip  on  the 
earth's  magnetic  equator  but  it  increases  toward  the 
poles.  Directly  over  the  latter,  the  angle  of 
inclination  is  exactly  90°. 

Iron  bars  set  upright  for  a  long  time  acquire  mag- 
netism from  the  earth.  The  earth's  magnetism  varies 
from  place  to  place  on  the  surface  of  the  earth  and 
there  are  daily,  annual,  secular  and  irregular  varia- 
tions, which  are  associated  with  modifying  solar 
activity.  Magnetic  storms  have  been  attributed  to  a 
number  of  unusual  spots  on  the  sun,  volcanic 
eruptions  and  electric  currents  in  the  atmosphere. 
Many  attempts  have  been  made  to  explain  the  cause 
of  the  earth's  magnetism.  It  has  been  attributed  to 
the  presence  of  large  quantities  of  magnetized  iron 
below  the  earth's  surface,  to  induction  from  the  sun 

• 

(which  Biot  claimed  is  itself  a  powerful  magnet), 
and  to  currents  of  electricity  flowing  .around  the 
earth.  The  latter,  the  theory  of  Ampere,  is  the  most 
suggestive. 

141 


Progressive     Spondylotherapy 


CHAPTER  IX. 

MAGNETIC  FORCE 
PHYSIOLOGICAL  PHYSICS 

ANIMAL  TISSUES— MAGNETISM  AND  VISCERAL  TONE — ACTION  ON 
VOLUNTARY  MUSCLES— VISCERAL  ATTRACTION  AND  REPUL- 
SION—VISCERAL DEMAGNETIZATION— LOCAL  DEMAGNETIZA- 
TION— TRANSMISSION  OF  FORCE — MISCELLANEOUS  EFFECTS. 

It  is  the  object  of  the  author  in  this  chapter  to 
submit  a  few  observations  in  a  direction  believed  to 
be  substantially  new,  and  to  present  succintly  in  the 
subsequent  chapter  some  conclusions  based  on  these 
premises.  The  writer  acknowledges  the  incomplete- 
ness of  his  observations  which  have  only  extended 
over  a  period  of  three  months  and  he  also  admits  that 
his  limited  knowledge  of  physics  deters  him  from 
interpreting  more  fully  the  observed  phenomena. 

Hypotheses  have  been  eliminated  and  only  facts 
are  presented. 

When  Kirchoff,  thrust  between  the  image  of  the 
sun  from  the  heliostat  and  the  tinted  band  of  his 
spectroscope,  a  flame  of  sodium  vapor,  and  instead  of 
the  expected  brightening,  saw  the  band  darkened,  he 
left  his  laboratory  hastily  with  the  words,  "That 
seems  to  me  a  fundamental  fact." 

If  certain  fundamental  facts  have  been  established 
by  the  author  he  anticipates  their  elaboration  by 
physicists,  psychologists  and  others  more  competent 
than  himself. 

Some  of  the  author's  observations  would  have  been 
impossible  of  attainment,  if  it  were  not  for  the  fact 
that  the  reflexes  of  the  organs  (page  120)  can  now  be 
recognized  objectively. 

142 


Physiological       Physics 

Considering  the  discredit  cast  on  the  therapeutic 
employment  of  the  magnetic  force,  all  consideration 
of  this  subject  will  be  evaded,  so  that  the  reader  is 
constrained  to  formulate  his  own  conclusions. 

My  investigations  were  made  with  feeble  and 
powerful  magnets  (Fig.  32). 

Animal  tissues. — Any  material  in  which  magnetism 
may  be  induced  and  which  is  therefore  attracted  by 
a  magnet  is  magnetic  material. 


FIG.  32. — Giant  and  smaller  electromagnet.  The  giant  magnet  has  a 
lifting  power  of  approximately  400  pounds  to  the  square  inch.  The  smaller 
electromagnet  has  a  little  over  one-fourth  the  strength  of  the  giant  mag- 
net. 

If  any  of  the  human  tissues  are  suspended  on  a 
light  silk  thread  near  a  magnet,  the  latter  will  attract 
one  pole  of  the  tissue  and  repel  the  other.  The  north 
pole  of  the  magnet  repels  the  north  pole  of  the  tissue 
and  attracts  its  south  pole. 

The  foregoing  effect  varies  with  the  tissues  em- 
ployed and  is  best  exhibited  by  nerves,  whereas  the 
least  effect  is  noted  with  the  spinal  cord. 

The  same  magnetic  attraction  is  exhibited  by  the 
membranous  coverings  of  the  nervous  system, 

143 


Progressive     Spondylo  therapy 

organs  and  muscles.  It  has  always  been  contended 
that  these  membranes  act  as  electric  insulators  to 
retain  the  normal  quantity  of  electricity  in  the  fore- 
going structures.  One  knows  that,  magnetism 
induced  in  a  bar  of  iron  may  induce  magnetism  in 
another  piece  so  that  a  magnet  may  be  made  to 
support  a  number  of  nails  end  to  end,  each  of  which 
has  become  a  magnet  by  induction. 

The  foregoing  effect  may  also  be  observed  with 
the  tissues. 

An  ordinary  bar  or  horse-shoe  magnet  will  also  at- 
tract the  tissue  although  the  force  thus  exhibited  is 
very  feeble  in  comparison  with  an  electromagnet.  The 
iron-content  of  the  tissues  has  without  doubt  some 
effect  on  the  results  yet,  the  liver  and  spleen  which  in 
the  norm  show  a  high  content  of  iron  exhibit  a  feebler 
power  of  attraction  than  the  nerves.  Even  after  the 
tissue  has  been  immersed  In  a  solution  to  dissolve  any 
iron  which  may  be  present,  the  tissue  is  attracted  to 
the  magnet  although  less  readily  than  before.  Here 
one  must  assume  some  change  in  the  molecular 
arrangement  of  the  tissue. 

Fresh  tissues  do  not  show  the  foregoing  properties 
of  attraction  or  repulsion.  The  tissue  must  first  be 
allowed  to  dessicate  naturally.  If  the  tissues  are 
artificially  dessicated  the  results  are  compromised. 
The  tissue  must  be  deprived  of  blood.  The  latter 
although  containing  iron  is  diamagnetic. 

Experimenting  largely  with  nerves,  the'  results 
were  never  uniform.  This  may  have  been  caused 
by  varying  degrees  of  dessication  or  for  other  reas- 
ons which  I  do  not  know.  Thus,  as  this  manuscript 
is  about  to  go  to  press,  I  repeated  my  earlier  ex- 
periments with  negative  results.  Unfortunately, 
time  will  not  permit  me  to  determine  the  cause 
for  this  discrepancy. 

Severed  nerves   in   chloroformed  animals   prox- 

144 


Physiological       Physics 

imally  connected  with  the  spinal  cord,  exhibited  less 
magnetic  attraction  than  nerves  removed  from  the 
body  and  suspended  by  a  thread.  The  reason  for  this 
is  noted  on  page  159. 

About  the  year  1819,  Oersted,  in  investigating  the 
relation  existing  between  magnetism  and  electricity 
found  that,  when  an  electric  current  flows  through 
a  conductor,  a  magnetic  flux  is  created  which  makes 
the  conductor  a  magnet.  The  conductor  loses  its  niag- 
netic  properties  as  soon  as  the  current  ceases  to  flow. 
The  nature  of  the  material  through  which  the  current 
flows  is  of  no  importance.  In  my  investigations  using 
various  organs  and  tissues  as  conductors,  a  decided 
difference  was  noted  in  the  deflection  of  the  needle. 

The  close  resemblance  between  electricity  and  mag- 
netism was  further  emphasized  by  the  discovery  of 
Faraday,  in  1831.  The  latter  found  that,  whenever 
lines  of  magnetic  flux  are  caused  to  cut  or  pass 
through  conductors  so  connected  as  to  form  closed 
circuits,  currents  of  electricity  are  generated. 

ACTION  OF  MAGNETISM  ON  VISCERAL  TONE. — On  pages 
62  and  124  reference  was  made  respecting  what  is 
understood  by  tone  of  the  organs.  Perhaps  the  most 
conspicuous  physiologic  manifestation  exhibited  by 
the  forces  is  that  of  increasing  vital  tone. 

In  this  respect,  the  magnetic  force  is  insuperable. 

On  page  121,  the  reflexes  of  the  organs  were  like- 
wise discussed.  It  was  noted  that  different  stimuli 
applied  to  definite  regions  of  the  spinal  cord  would 
cause  either  a  contraction  or  dilatation  of  various 
organs. 

The  stomach  was  employed  as  a  vehicle  for  the 
exhibition  of  such  effects.  When  the  stomach-tone  is 
employed  as  a  test  for  the  action  of  the  forces,  a 
moderately  thin  subject  must  be  selected  and  the. 
entire  abdomen  must  yield  a  tympanitic  tone  on  pe.r- 

145 


Progressive     Spondylotherapy 

cussion.  A  normal  subject  must  likewise  be  selected 
otherwise  the  results  will  be  modified.  Percussion 
must  be  executed  during  the  time  the.  patient  stands. 
No  results  can  be  expected  in  any  other  posture. 

Now,  in  the  application  of  the  stimulus  to  the  region 
of  the  7th  cervical  vertebra,  two  effects  could  be 
elicited:  increased  tone  of  the  stomach  or  the  latter 
plus  contraction  of  the  organ. 


FIG.  33. — Illustrating  the  area  9f  the  stomach  by  percussion  before 
(continuous  line)  and  after  concussion  of  the  7th  cervical  spine  (broken 
line).  The  reduction  in  area  is  known  as  the  stomach  reflex,  of  con- 
traction. 

The  former  effect  was  ascertained  by  dullness  on 
percussion  (page  123)  and  the  latter,  by  dullness  plus 
recession  of  the  lower  border  of  the  stomach.  Heat, 
light,  radium,  X-rays  and  magnetism,  when 
permitted  to  act  in  the  region  of  the  7th  cervical 

146 


Physiological       Physics 

spine  produced  a  dullness  corresponding  to  the 
stomach  approximating  the  anterior  abdominal  wall. 
With  all  the  forces  excepting  magnetism,  this  dull- 
ness was  of  brief  duration  and  was  soon  succeeded 
by  the  normal  tympanitic  tone  on  percussion.  If  the 
stimulus  employed  was  concussion  by  aid  of  an 
electric  hammer  striking  a  series  of  rapid  blows  vary- 
ing in  strength  from  6  to  12  pounds,  in  association 
with  dullness  of  the  stomach  the  organ  became 
contracted  (Fig.  33). 

The  latter,  known  as  the  stomach  reflex  of  contrac- 
tion, remains  contracted  for  about  15  minutes  after 
which  time  it  gradually  resumes  its  former  position. 
The  longest  duration  of  the  latter  reflex  noted  by 
concussion  was  20  minutes. 

It  is  evident  that  the  duration  and  the  amplitude 
of  the  reflex  are  determined  by  the  vigor  of  the 
muscular  fibers  of  the  stomach.  When  the  magnetic 
flux  is  permitted  to  act  on  the  region  of  the  7th 
cervical  vertebra,  unlike  the  other  forces  which  are 
transitory  in  action,  it  will  produce  a  dullness  of  the 
stomach  lasting  for  many  hours  without  causing  the 
stomach  to  recede. 

All  forces  show  this  action  (of  temporary  dura- 
tion), on  the  tone  of  the  stomach  applied  at  the  spinal 
region  mentioned  or  at  a  distance  from  the  subject 
but  the  magnetic  force  will  exhibit  such  action  lasting 
for  hours  and  at  a  greater  distance.  Thus,  with  the 
small  electro-magnet  (Fig.  32),  this  dullness  of  the 
stomach  can  be  elicited  at  a  distance  of  30  feet  and 
with  the  large  magnet  (Fig.  32),  at  a  distance  greater 
than  60  feet.  In  both  instances  the  dullness  per- 
sisted for  a  variable  period  of  time  after  the  magnetic 
flux  has  ceased  to  flow. 

If  a  patient  enters  a  room  in  which  the  magnetic 
flux  has  been  allowed  to  flow  for  several  minutes,  a 

147 


Progressive     Spondylotherapy 

stomach  previously  showing  a  tympanitic  tone  on 
percussion;  will  yield  a  dull  sound  within  20  seconds. 
The  latter  dullness  is  of  considerable  duration.  One 
of  the  most  important  observations  concerns  the  con- 
veyance of  the  magnetic  force  by  an  individual.  If  an 
individual  exposes  himself  for  about  one  minute  to 
the  flux  of  a  giant  magnet  and  then  enters  another 
room  (time  should  not  exceed  30  seconds),  and  stands 
alongside  an  individual  with  exposed  abdomen,  per- 
cussion will  demonstrate  in  the  latter  a  dullness  of 
the  stomach.  This  dullness  will  last  for  several  min- 
utes. 


FIG.  34. — Apparatus  for  recording  wireless  messages  with  the  leg  of 
a  frog;  A,  nerve;  B,  muscle.  The  attached  tracing  represents  a  record. 

No  dullness  ensues  until  the  individual  exposed 
to  the  flux  is  alongside  of  the  person  examined. 
It  is  evident  therefore  that  the  action  is  one  of 
propinquity  and  not  due  to  the  influence  of  the 
flux  at  a  distance. 

The  augmented  tone  of  the  musculature  of  the  stom- 
ach may  be.  accepted  as  a  delicate  physiologic  test  for 
the  presence  of  the  magnetic  force.  In  other  words  it 
can  be  used  as  a  magnetometer. 

148 


Physiological      Physics 


A  frog  is  used  as  a  delicate  physiologic  test  for 
strychnin  and  the  same  animal  is  used  for  detect- 
ing adrenalin  which  dilates  the  frog's  pupil.  An- 
other delicate  test  for  adrenalin  is  the  increased 
tone  produced  in  the  stomach-musculature  of  the 
frog  whereas  in  mammals,  the  effect  is  to  relax 
the  muscle. 

Fig.  34,  shows  a  frog's-leg  receiver  recently 
employed  by  a  French  physiologist  for  recording 
wireless  messages.  The  sciatic  nerve  of  the  leg 
is  __  connected  into  the  microphone^circuit  of  the 
receiver.  One  end  of  the  leg  is  fixed  to  a  base  and 
the  other  end  connected  with  a  pivoted  lever  which 
records  on  a  drum  revolved  by  clock-work,  the  con- 
tractions of  the  muscles  caused  by  the  electrical 
impulses. 

If  the  region  of  the  7th  cervical  vertebra  is  first 
concussed  and  then  the  body  (in  proximity  to  the 
magnet)  is  exposed  to  the  magnetic  flux,  the  stomach 
will  remain  contracted  for  hours.  In  other  words,  the 
magnetic  force  will  fix  the  organ  in  the  position  in 
which  it  has  been  placed  by  concussion. 

One  may  employ  the  same  maneuver  in  fixing  the 
heart,  aorta,  liver  and  other  organs  either  in  a  state  of 
contraction  or  dilatation.  These  effects  may  be  pro- 
longed by  color  (page  130).  The  best  results  however, 
are  attained  by  allowing  the  magnetic  flux  to  act  for 
several  minutes  at  the  regions  of  the  spine  where  the 
reflexes  are  elicited  by  concussion. 

The  researches  of  the  author  show  that  the 
organs  may  be  made  to  contract  or  dilate  by  irri- 
tating the  skin  over  the  organ.  The  reflexes  thus 
evoked  explain  our  empirical  methods  of  treatment 
by  liniments,  poultices,  water  and  a  host  of  physical 
remedies.  The  skin  reflexes  are  infiinitesimal  in 
amplitude  and  duration  when  compared  with  the 
reflexes  evoked  from  the  spinal  region  which  last 
for  hours. 

The  skin  reflexes  may,  however,  be  fixed  for  a 
greater  duration  of  time  if  the  magnetic  flux  is  al- 
lowed to  flow  during  their  elicitation. 

149 


Progressive     Spondylotherapy 

Thus,  the  heart  reflex  of  contraction  by  scratch- 
ing the  skin  over  the  heart  (allowing  the  magnetic 
flux  to  act  only  during  the  scratching  process)  will 
last  5  minutes  compared  with  a  duration  of  20  sec- 
onds before  the  flux  is  allowed  to  flow. 

All  the  skin  reflexes  after  the  patient  has  been 
exposed  to  the  flux  are  greater  in  amplitude  and 
duration. 

One  may  formulate  the  following  constant:  The 
duration  and  amplitude  of  a  visceral  reflex  is  in 
direction  proportion  to  the  intensity  of  the  magnetic 
flux  and  its  proximity  to  the  spinal  region  governing 
a  given  reflex. 


FIG.  35. — Tracings  of  the  pulse;  A,  before  the  tip  of  the  electromag- 
net is  placed  at  the  7th  cervical  spine;  B,  during  the  time  the  flux  is  first 
allowed  to  flow  and  C,  about  30  seconds  thereafter. 

The  effect  of  the  flux  on  the  heart  is  easily  ascer- 
tained by  palpation  of  the  pulse  before  and  during 
the  action  of  the  flux.  With  the  patient  in  juxtapo- 
sition to  a  large  electro-magnet,  the  pulse  becomes 
feeble  and  is  inhibited  or  nearly  so.  These  effects  are 
accentuated  when  the  magnetic  force  is  allowed  to  act 
directly  on  the  region  of  the  7th  cervical  vertebra. 
(Fig.  35). 

It  is  indeed  strange  how  little  of  the  magnetic  flux 
is  necessary  to  increase  the  tone  of  the  organs.  An  or- 
dinary bar  or  horse-shoe  magnet  impinging  on  the 
stomach,  heart  or  any  of  the  organs  will  at  once  (by 
increasing  the  tone  of  the  organs),  bring  out  an  area 
of  increased  dullness. 

The  organs  are  ordinarily  in  a  varying  state  of 
tonicity.  The  tone  of  the  organ  may  be  normal 
(orthotonic),  increased  (hypertonic),  diminished 
(hypotonic)  or  absent  (atonic). 

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Physiologi  c  a  1       Physics 

A  relaxed  organ  will  yield  a  smaller  area  of 
dullness  than  an  organ  which  is  in  a  state  of  tone. 
To  accurately  reproduce  the  area  occupied  by  an 
organ,  it  must  be  put  in  a  condition  of  augmented 
tone,  otherwise  percussion  will  yield  untrustworthy 
results. 


FIG.  36. — Illustrating  the  employment  of  an  ordinary  horseshoe  mag- 
net for  outlining  the  boundaries  of  the  heart  and  liver.  The  broken  lines 
show  the  boundaries  before,  and  the  continuous  lines,  after  the  use  of  the 
magnet  held  by  the  patient  in  the  center  of  the  organ.  The  stomach  in  the 
norm  cannot  be  defined  by  percussion  owing  to  the  tympanitic  quality  of 
its  sound.  In  this  illustration,  the  magnet  placed  in  the  stomach  region 
caused  a  dullness  of  the  organ  thus  permitting  its  delimitation. 


In  Fig.  36,  the  organs  are  percussed  before  and 
after  an  ordinary  magnet  is  held  by  the  patient  in 
the  region  of  the  organs. 

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Progressive     Spondylotherapy 


In  Fig.  37,  the  aorta,  heart,  liver  and  spleen  are 
percussed  before  and  after  the  flux  of  an  electro- 
magnet is  allowed  to  flow.  In  the  latter  instance, 
the  patient  stands  in  juxtaposition  but  not  in  con- 
tact with  the  magnet. 


FIG.  37 — Percussion  of  the  heart  and  liver  before  (broken  lines)  and 
after  (continuous  lines)  the  subject  is  in  proximity  to  a  giant  magnet. 
The  outline  of  the  stomach  was  determined  during  the  flow  of  the  mag- 
netic flux. 

In  a  subject  with  a  responsive  stomach-muscle,  one 
may  increase  the  tone  of  the  stomach  (as  shown  by 
dullness  on  percussion)  at  a  distance  of  over  80  feet. 

The  foregoing  stomach-reaction  represents  the 
basis  of  most  of  my  investigations. 

The   stomach   cannot  be   defined   by  our   usual 
methods  of  percussion.    The  tympanitic  tone  of  the 

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Physiological       Physics 

organ  cannot  be  accurately  differentiated  from  the 
tympanitic  tone  of  the  intestines.  It  must  be  ob- 
served that  the  tympanitic  tone  of  the  intestines 
is  partially  changed  to  dullness  by  the  magnetic 
flux  (owing  to  the  tone  imparted  to  them),  but  the 
dullness  is  not  as  pronounced  as  that  of  the  stomach 
hence  the  possibility  of  differentiation  by  percussion. 

It  has  been  shown  (page  123)  that,  by  artificial 
stimulation  of  the  vagus,  one  may,  by  increasing  the 
tone  of  the  stomach,  cause  the  latter  to  yield  to  a  dull- 
ness on  percussion.  If,  however,  one  injects  1/60 
grain  of  atropin  (which  paralyzes  the  motor  endings 
of  the  vagus),  artificial  stimulation  of  the  vagus  after 
the  manner  cited  is  incapable  of  increasing  the  tone 
of  the  stomach.  In  other  words,  one  cannot  elicit  the 
stomach  reflex.  If,  after  atropin  is  injected  and  the 
patient's  body  is  in  proximity  to  a  powerful  electro- 
magnet, the  tone  of  the  stomach  is  nevertheless  re- 
stored as  evidenced  by  the  dullness  on  percussion. 

The  foregoing  is  noted  with  reference  to  all  the  or- 
gans supplied  by  the  vagus  and  is  surprising  consid- 
ering the  fact  that  the  magnetic  force  can  restore  tone 
quite  independent  of  nerve-force.  This  statement 
demands  modification  as  shown  on  page  164. 

If  an  individual  is  in  an  electromagnetic  field  be- 
tween like  poles  of  two  electromagnets  no  dullness  of 
the  stomach  can  be  elicited  and  the  same  effect  is  man- 
ifest if  the  poles  are  unlike  (Fig.  38). 

If  the  dullness  of  the  stomach  is  evoked  by  expos- 
ure to  the  streamings  of  either  the  north  or  south  pole 
of  a  magnet,  it  can  be  made  to  disappear  at  once  by 
exposure  to  the  pole  opposite  to  that  which  first  caus- 
ed the  dullness. 

The  foregoing  is  in  accordance  with  one  of  the  laws 
of  magnetic  force,  the  poles  of  opposite  name  neutral- 
ize one  another. 

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Progressive     Spondylotherapy 

Exposure  of  the  subject  to  two  like  poles  of  a  mag- 
net multiplies  the  intensity  of  the  dullness;  the 
streamings  being  concentrated  anteriorly  on  the 
stomach-region. 


FIG.  38. — Illustrating  the  forces  producing  attraction  between  unlike 
poles  and  repulsion  between  like  poles.  The  interposition  of  the  body  in 
both  instances  yields  negative  results  owing  to  neutralization  of  unlike 
poles  and  the  repulsion  of  like  poles. 

It  has  been  observed  that  whereas  the  magnetic 
force  increases  the  tone  of  the  organs  it  neither  con- 
tracts nor  dilates  them. 

In  my  earlier  investigations  errors  of  interpreta- 
tion ensued  with  reference  to  the  foregoing. 

Thus,  when  the  magnetic  force  was  allowed  to  act 
for  several  minutes  in  the  region  of  the  7th  cervical 
spine,  prolapsed  stomachs  were  hauled  up  a  consider- 
able distance.  In  all  such  instances,  I  was  dealing 
with  relaxed  (hypotonic  or  atonic  viscera)  organs.  In 
the  norm,  however,  such  effects  are  not  observed ;  the 

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Physiological       Physics 

tone  of  the  organ  is  augmented  but  there  is  no  change 
in  its  position. 

An  important  fact  in  the  use  of  the  magnetic  force 
is  that  there  is  no  danger  of  exhausting  the  tone  of  the 
organs  nor  in  fixing  a  reflex  from  excessive  stimula- 
tion and  furthermore,  in  increasing  the  tone  and  in 
fixing  a  reflex,  a  seance,  need  not  exceed  five  minutes. 

Physicists  have  demonstrated  the  fact  that,  under 
constant  magnetizing  force  the  magnetism  will  go  on 
slowly  and  slightly  increasing  for  a  long  time,  a  phe- 
nomenon called  magnetic  creeping. 

ACTION  ON  VOLUNTARY  MUSCLES. — In  considering 
the  action  of  the  magnetic  flux  on  the  organs,  we  were 
dealing  with  visceral  muscle  (pages  7  and  147).  It  is 
not  easy  to  gauge  the  action  of  magnetic  force  on  vol- 
untary muscles  insomuch  as  it  is  difficult  to  exclude 
expectant  attention  and  the  personal  equation.  How- 
ever certain  phenomena  are  quite  evident. 

The  magnetic  force  is  in  no  sense  an  excitant  but  a 
tone-producing  force.  Making  and  breaking  the  cur- 
rent of  an  electromagnet  is  without  any  effect  and  im- 
parts no  tone  to  the  organs.  With  the  patient  ap- 
proximating a  giant  magnet,  fully  10  seconds  elapse 
before  the  tympanitic  sound  of  the  stomach  is  con- 
verted into  dullness. 

The  magnetic  force  permitted  to  act  on  voluntary 
muscles  gives  absolutely  no  evidence  of  its  action  de- 
spite the  fact  that  augmented  tone  is  imparted  to 
them  just  as  it  is  to  visceral  muscle. 

If,  one  percusses  any  voluntary  muscle  during  the 
time  the  percussed  part  is  adjacent  to  the  source  of 
the  magnetic  flux,  the  muscle  bulges  and  in  suscept- 
ible subjects  a  spasmodic  contraction  ensues  which 
may  persist  even  after  the  flux  ceases  to  flow. 

The  biceps  (arm)  is  a  suitable  muscle  for  such  ex- 

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Progressive     Spondylotherapy 

perimentation.    The  same  phenomena  may  be  observ- 
ed in  the  exposed  muscles  of  a  vivisected  animal. 

If  a  relaxed  scrotum  is  exposed  to  the  flux  there  is 
no  retraction  of  the  testes  but,  if  during  the  tune  of 
the  exposure,  the  cremasteric  reflex  is  elicited  several 
times,  the  scrotum  shrinks  quite  perceptibly.  The 
use  of  electricity  is  more  exact. 

One  may  note  that,  the  reaction  of  the  muscles  is  ac- 
centuated when  the  electricity  is  applied  during  the 
time  the  part  is  in  proximity  to  an  electromagnet. 

The  augmented  reaction  is  quite  evident  and  per- 
sists after  the  magnetic  force  is  discontinued.  The 
foregoing  results  are  only  noted  after  the  parts  have 
been  exposed  to  the  magnetism  for  about  one  minute. 
The  augmented  reaction  depends  on  which  pole  of 
the  magnet  is  directed  toward  the  part  acted  upon  by 
the  electricity  and  which  pole  of  the  latter  is  used. 

If  the  muscle  is  first  demagnetized  (page  161),  the 
intensity  of  the  muscle-reaction  becomes  less  evident. 

VISCERAL  ATTRACTION  AND  REPULSION. — If  one  first 
determines  the  lower  border  of  the  liver  by  percus- 
sion, and  fixes  at  a  definite  point  below  the  site  of 
dullness,  the  tip  of  a  giant  electromagnet  and  again 
determines  the  lower  liver-border,  the  latter  will  be 
found  to  descend  one  or  more  centimeters  during  the 
time  of  the  flow  of  the  magnetic  flux.  The  moment  the 
flow  of  the  latter  ceases,  the  liver-border  regains  its 
former  position. 

The  following  facts  were  determined : 

1.  The  tip  of  the  magnet  placed  below  the  stomach, 
spleen  and  kidneys  will  elicit  the  same  phenomenon 
during  the  flow  of  the  flux. 

2.  Placing  the  tip  above  the  anatomic  site  of  the 

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Physiological       Physics 

abdominal  organs  cited,  the  organs  rise  only  during 
the  flow  of  the  flux. 

3.  If  the  liver  (and  the  same  applies  to  the  other 
abdominal  organs),  is  first  charged  (for  about  one 
minute)  with  the  north  pole  of  the  electromagnet  and 
the  tip  of  the  latter  pole  is  placed  below  the  liver- 
border,  instead  of  a  decent  of  the  latter,  it  rises.    In 
other  words,  it  is  repelled.  • 

4.  If  the  liver  is  first  charged  from  the  south  pole, 
the  degree  of  its  descent  with  the  north  pole  is  greater 

than  when  it  is  not  charged  at  all. 

i 

5.  If  any  of  the  spinous  processes  are  concussed 
(excepting  the  7th  cervical  spine),  for  one  or  more 
minutes,  it  is  impossible  to  cause  any  descent  of  the 
liver,  stomach  or  spleen.    It  is  known  that  jarring  or 
a  few  sharp  strokes  of  a  hammer  may  cause  the  great- 
er part  of  the  magnetism  to  disappear  in  a  magnet. 

If  one  however,  concusses  the  7th  cervical  spine 
which  stimulates  the  vagus  and  causes  the  liver, 
spleen  and  stomach  to  contract  (reflexes  of  contrac- 
tion), the  mechanic  agitation  is  counterbalanced  by 
the  stimulating  impulses  conveyed  to  the  organs  in 
question. 

If  the  region  between  the  3rd  and  4th  dorsal  spines 
is  concussed  and  the  tip  of  the  magnet  is  placed  at  a 
fixed  point  below  the  liver,  the  latter  is  repelled.  Con- 
cussion of  this  region  stimulates  the  sympathetic 
nerves  (at  the  expense  of  the  pneumogastric  nerves), 
and  has  a  conspicuous  action  in  reducing  the  nerve- 
tone  of  the  organs  (page  162). 

The  heart  has  an  important  influence  on  the  posi- 
tion of  the  abdominal  organs  as  one  can  readily  deter- 
mine (selecting  the  liver  for  demonstration)  by  per- 
cussion. This  influence  is  modified  according  to 

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Progressive     Spondylotherapy 

whether  the  heart-region  is  positively  (N-pole)  or 
negatively  charged  (S-pole). 

6.  If  the  tip  of  the  magnet  is  placed  at  a  fixed 
point  below  the  spleen,  the  descent  of  the  latter  is 
greater  at  its  anterior  extremity  than  in  the  center 
of  the  organ. 

Regarding  the  spleen  (like  other  organs)  as  a  mag- 
netic structure,  its  greatest  attractive  force  would  be 
at  its  anterior  and  posterior  ends. 

In  attempting  to  control  by  the  X-rays  the 
results  obtained  on  the  organs  by  percussion,  I 
found  it  was  often  impossible.  It  was  found  that  the 
X-rays  in  a  powerful  magnetic  field  were  deflect- 
ed from  the  target  of  the  tube  first  in  one  and  then 
in  the  other  direction  according  to  whether  the 
north  or  south  pole  of  the  electro-magnet  was  pre- 
sented toward  the  tube  (Fig.  39).  These  effects 
were  only  observed  after  the  tube  had  reached  a 
certain  degree  of  hardness. 

The  original  theory  of  Stokes,  that  the  Roentgen 
rays  consisted  of  sets  of  ether-ripples  was  generally 
accepted  despite  the  fact  that  there  was  no  evi- 
dence of  refraction,  reflection  or  diffraction.  Fail- 
ure of  the  most  powerful  magnetic  fields  to  create 
deviation  favored  the  etheric  rather  than  a  corpus- 
cular theory.  More  recent  investigations  of 
Bragg15,  seem  to  prove  that  the  X-rays  are  of  two 
kinds ;  reflecting  and  non-reflecting  rays. 

Electro-optical  phenomena  are  many.  Fara- 
day, discovered  that  a  wave  of  light  polarised  in  a 
certain  plane  can  be  twisted  round  by  the  action 
of  a  magnet  so  that  the  vibrations  are  executed  in 
a  different  plane. 

In  1877,  Kerr,  showed  that  a  ray  of  polarized  light 
is  likewise  rotated  when  reflected  at  the  surface  of  a 
magnet. 

Kundt,  demonstrated  that  the  plane  of  polariza- 
tion of  light-waves  is  also  rotated  if  the  light 
traverses  an  almost  transparent  film  of  iron  placed 
transversely  in  a  magnet  field. 

Attempts  to  prove  visceral  attraction  and  repulsion 
in  animal-experiments  were  negative.  Further  inves- 

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Physiological      Physics 

tigations  demonstrated  the  reason  for  the  latter.  In 
the  human,  a  few  whiffs  of  chloroform  or  ether  even 
when  mixed  with  oil  of  orange  (page  82),  destroys  at 
once  any  downward  pull  of  the  viscera  by  the  mag- 
netic force.  If  a  solution  of  cocain  is  used  in  the  nose, 
the  organ  (e.  g.,  liver)  instead  of  being  pulled  down- 


FIG.  39. — Illustrating  deflection  of  X-rays  in  a  powerful  magnetic 
field  The  upper  tube  shows  the  rays  before  the  flux  is  permitted  to  flow. 
This  illustration  inadequately  exhibits  the  pronounced  deflection  asso- 
ciated with  a  tube  of  a  definite  degree  of  hardness. 


ward  is  actually  repelled.  Fright  or  fear  likewise  de- 
stroys the  downward  pull  on  the  organ.  The  emotions 
increase  the  adrenalin  in  the  blood  which  annihilates 
the  tone  of  the  organs  (page  8). 

Experiments  with  the  exsected  stomach  were  equal- 
ly negative  in  accordance  with  the  well-known  physio- 
logic observation  that,  smooth  muscle  cut  out  of  the 
body  passes  at  once  into  a  state  of  tonic  contraction 
lasting  for  hours. 

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Progressive     Spondylotherapy 


The  physiologist  who  discredits  observations 
made  without  the  domain  of  his  laboratory  seems  to 
'forget  that  disease  is  practically  an  experiment  of 
nature  under  abnormal  conditions.  All  physiologic 
experiments  made  in  the  laboratory  are  equally  con- 
ducted under  adverse  conditions. 


FIG.  40. — Helix  and  coil  of  wire  (indicated  by  arrow)  for  demag- 
netization. 

VISCERAL  DEMAGNETIZATION. — Demagnetization  is 
effected  by  magnetizing  in  opposite  directions  and,  by 
decreasing  the  intensity  of  the  current,  the  magnet- 
ism is  gradually  reduced  to  zero.  In  other  words,  to 
demagnetize  an  object,  one  subjects  it  to  a  series  of 
cycles  of  diminishing  intensity. 

With  the  alternating  current,  a  rheostat  is  the 
only  adjunct  necessary  for  demagnetization. 

If  only  the  constant  current  is  at  command,  one 

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Physiological       Physics 

may  use  a  transformer  or  a  cheaper  substitute  con- 
sisting of  a  double-throw  pole-switch  arrangement 
and  gradually  reduce  the  current  by  means  of  a 
water-rheostat. 

To  demagnetize  the  body,  the  author  employs  a  un- 
iversal and  a  local  method.  In  the  universal  method, 
a  demagnetizing  coil  is  used  consisting  of  a  helix  6 
feet  in  length  and  of  sufficient  diameter  to  enclose  an 
individual.  It  consists  of  188  turns  of  bare  copper 
wire  wound  on  a  wooden  frame  (Fig.  40). 

In  the  local  method,  a  coil  of  wire  is  wound  around 
a  piece  of  soft  iron  (Fig.  40). 

If  an  individual  enters  the  helix  and  demagnetiza- 
tion is  executed  for  several  minutes,  it  is  impossible 
to  percuss  the  stomach  even  though  the  vagus  is  stim- 
ulated artificially.  This  action  may  persist  for  hours. 
The  abdominal  organs  (liver,  spleen,  stomach),  lie 
lower  and  it  is  impossible  to  elicit  visceral  attraction 
and  repulsion  (page  156). 

LOCAL  DEMAGNETIZATION. — It  has  been  shown  that 
the  organs  are  dominated  by  two  sets  of  nerve-fibers 
which  are  opposite  in  action  and  which  for  conveni- 
ence may  be  grouped  as  vagus  and  sympathetic-fibers. 

The  vagus-fibers  maintain  the  organs  in  a  state  of 
contraction  whereas  the  sympathetic-fibers  strive  to 
keep  them  in  a  state  of  dilatation.  When  both  sets  of 
fibers  are  in  a  state  of  physiologic  tone  the  organs  are 
neither  contracted  nor  dilated  but  in  a  condition  of 
equipoise. 

If  we  stimulate  the  vagus-fibers  at  the  7th  cervical 
spine,  we  contract  the  heart,  aorta,  stomach,  li ver  and 
spleen. 

If  one  stimulates  the  sympatheic-fibers  at  a  point 
between  the  3rd  and  4th  dorsal  spines,  there  is  a  dila- 
tation of  the  foregoing  structures. 

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Progressive     Spondylotherapy 

By  the  foregoing  maneuver,  we  have  imparted  tone 
to  the  vagus  or  sympathetic  fibers. 

The  magnetic  force  is  the  equivalent  of  tone  (page 
124)  insomuch  as  by  its  use  a  like  effect  is  attained. 

Demagnetization  corresponds  to  the  removal  of 
tone.  If  one  applies  the  extremity  of  the  iron  rod 
(Fig.  40)  to  the  7th  cervical  spine  and  executes  de- 
magnetization for  several  minutes,  the  tone  of  the  or- 
gans supplied  by  the  vagus-fibers  is  annihilated  and 
the  action  of  the  sympathetic-fibers  on  the  organs  be- 
comes dominant. 

In  consequence  of  the  foregoing,  percussion  will 
show: 

1.  Dilatation  of  the  heart  and  aorta ; 

2.  Enlargement  of  the  stomach,  liver  and  spleen ; 

3.  Dilatation  of  the  intra-abdominal  veins. 

If  one  removes  the  tone  of  the  stomach  by  de- 
magnetization, how  can  one  demonstrate  enlarge- 
ment of  the  organ  by  percussion?  The  magnetic 
force  neither  contracts  nor  enlarges  an  organ  but 
merely  fixes  it  in  a  definite  position.  After  demag- 
netization of  the  vagus,  the  flux  is  directed  toward 
the  region  of  the  stomach  until  it  acquires  sufficient 
tone  to  yield  a  dullness  on  percussion.  After  this 
manner,  dilatation  and  descent  of  the  organ  may  be 
demonstrated. 

The  abstraction  of  tone  from  the  vagus  is  easily 
demonstrated. 

First  of  all,  one  must  know  that,  if  pressure  is  made 
in  the  region  of  the  7th  cervical  spine  the  pulse  can 
no  longer  be  felt  if  a  certain  degree  of  pressure  is  exe- 
cuted. The  greater  the  tone  of  the  vagus,  the  more 
pressure  is  necessary  to  stop  the  pulse. 

If,  in  a  given  case,  10  kilograms  of  pressure  are 
necessary  to  arrest  the  pulse  at  the  wrist  by  means  of 

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Physiological       Physics 

my  spondylopressor  (Fig.  1),  after  demagnetizing 
the  vagus  at  the  7th  cervical  spine,  the  pulse  will  be 
inhibited  with  a  pressure  of  3  or  4  kilograms. 


FIG.  41. — Illustrating  the  area  of  stomach-dullness  incident  to  the  in- 
gestion  of  water.  With  the  ingestion  of  9  ounces  of  water,  this  dullness 
continues  for  about  one  minute  but  it  persists  if  the  tone  of  the  organ 
is  removed  by  demagnetization  of  the  vagus. 

Another  simple  method  is  to  ingest  9  ounces  of  wat- 
er. In  the  norm,  this  produces  a  dullness  (Fig.  41) 
not  exceeding  one  minute.  If,  during  the  time  the 
water  is  ingested  and  demagnetization  is  executed  at 
the  7th  cervical  vertebra,  the  dullness  will  persist  dur- 
ing demagnetization  and  for  some  time  thereafter 
until  the  vagus  which  controls  the  output  of  water 
from  the  stomach  has  again  acquired  tone.  The  lat- 
ter may  be  acquired  at  once  by  exposing  the  subject 
to  the  magnetic  force. 

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Progressive     Spondylotherapy 

If  one  desires  to  remove  the  tone  of  the  sympathet- 
ic fibers,  the  rod  of  the  instrument  (Fig.  40)  is  fixed 
between  the  3rd  and  4th  dorsal  spines  and  the  effects 
noted  are : 

1.  Contraction  of  the  heart  and  aorta ; 

2.  Contraction  of  the  liver,  stomach  and  spleen ; 

3.  Contraction  of  the  intra-abdominal  vessels. 

In  the  latter  maneuver,  the  vagus-fibers  become 
predominant. 

After  the  tone  has  been  abstracted  from  the  vagus 
or  sympathetic  fibers  it  may  be  restored  at  once  by 
charging  the  former  with  the  magnetic  flux  at  the  7th 
cervical  spine  and  the  latter,  between  the  3rd  and  4th 
dorsal  spines. 

It  has  already  been  shown  (page  156)  that,  there  is 
such  a  condition  which  I  have  referred  to  as  visceral 
attraction  and  repulsion. 

If  one  demagnetizes  the  spleen  or  liver  by  applying 
the  rod  of  the  apparatus  (Fig.  40)  over  either  organ, 
neither  visceral  attraction  nor  repulsion  is  possible. 
In  demagnetizing  the  liver  after  the  foregoing  man- 
ner, the  organ  drops  lower  but  does  not  enlarge. 

When  demagnetization  is  attempted  over  the  heart- 
region,  there  is  a  drop  of  all  the  abdominal  organs 
including  the  kidneys. 

TRANSMISSION  OF  FORCE.* — When  one  strikes  a 
series  of  blows  corresponding  to  the  7th  cervical 
spine,  the  vagus  is  stimulated  (page  123). 

Physiologists  have  always  contented  themselves 
with  the  general  statement  that,  if  a  nerve  or  muscle 
is  irritated  a  stimulation  ensues. 

My  observations  show  that,  stimulation  is  equiva- 
lent to  the  discharge  of  force.  The  latter  statement 
can  be  readily  demonstrated. 

•Energy,  vide  preface  and  page  115. 

164 


Physiological      Physics 

If  during  the  time  the  7th  cervical  spine  of  one  sub- 
ject is  struck  a  series  of  blows  with  a  rubber-hammer, 
and  the  stomach-region  in  another  subject  standing 
in  juxtaposition  to  the  first  subject  is  percussed,  a 
dullness  can  be  demonstrated.  This  dullness  is  of  lim- 
ited duration  (about  30  seconds),  but  can  be  made  to 
reappear  by  repetition  of  the  blows.  It  will  also  be 
found  that,  the  increased  tone  produced  by  the  trans- 
mitted force  increases  the  tone  in  all  the  organs  sup- 
plied by  the  vagus  hence,  delimitation  of  the  latter  by 
percussion  will  be  facilitated  (page  184). 

Such  increase  in  the  tone  is  of  limited  duration  (30 
seconds)  hence  the  execution  of  percussion  must  not 
be  delayed. 

Concussion  of  other  vertebrae  is  negative  insomuch 
as  the  effect  is  tantamount  to  demagnetization  (page 
160).  Force  may  be  shown  to  be  transmitted  in  the 
following  ways : 

1.  By  contracting  the  muscles  of  one  arm  in  jux- 
taposition to  the  stomach-region.  When  the  two  arms 
are  forcibly  flexed,  no  dullness  of  the  stomach  ensues. 
It  is  necessary  to  determine  the  reason  for  the  latter, 
as  it  will  explain  a  host  of  phenomena. 

Physiologists  have  established  the  following  facts : 

a.  Electrical  currents  appear  in  the  body  when  a 
muscle  or  nerve  is  active  and  such  currents  are  inti- 
mately associated  with  the  functional  condition  of 
the  tissue. 

b.  These  action-currents  correspond  to  the  gen- 
eral  law    that,    every    active   portion   of   nerve   or 
muscle  maintains  a  negative  relation   toward  the 
resting  part.    In  other  words,  the  active  muscle  and 
nerve  show  a  negative  electrical  reaction  toward  the 
resting  muscle  and  nerve. 

c.  The  action-currents  of  muscle  and  nerve  are 
sufficiently  strong  to  have  a  stimulating  action  of 
their  own. 

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Progressive     Spondylotherapy 

It  is  assumed  by  the  author  that,  the  force  gener- 
ated say  in  the  one  arm  is  negative  and  in  the  resting 
stomach-muscle  it  is  positive  the  result  being  contrac- 
tion of  the  stomach-musculature.-  When  the  muscles 
of  both  arms  are  synchronously  contracted  a  number 
of  times,  there  is  a  discharge  of  two  negative  forces 
which  neutralize  one  another  with  negative  effects  on 
the  stomach-muscle. 

If  two  north  or  two  south  poles  of  two  magnets  are 
directed  in  the  region  of  the  stomach,  no  dullness  of 
the  stomach  is  elicited. 

The  foregoing  will  explain  subsequent  phenomena. 

2.  If  the  muscles  of  one  arm  of  the  subject  (in 
proximity  to  his  stomach-region)  are  brought  to  con- 
traction by  an  electric  current,  a  dullness  of  the  stom- 
ach ensues  but  if  the  muscles  of  both  arms  are  simul- 
taneously contracted,  there  is  no  dullness. 

Using  one  person  as  a  subject  and  contracting  the 
muscles  of  another  subject  (while  the  arms  are  in 
proximity  to  the  stomach-region  of  the  first  subject), 
like  effects  may  be  noted. 

Striking  the  arm-muscles  is  negative  in  its  results. 

3.  If  any  part  of  one  subject  is  brought  in  prox- 
imity to  the  stomach-region  of  another  subject  no 
dullness    ensues   except   when   the    heart-region   is 
brought  into  such  relation.    The  contact  must  be  im- 
mediate.    If,  however,  the  activity  of  the  heart  is 
augmented  by  inhalation  of  amyl  nitrite,  the  effect  is 
noted  at  a  distance  of  several  inches. 

4.  Stimulation  of  the  muscles  of  a  dead  frog  (the 
muscles  still  responding  to  electricity),  will  produce 
the  effects  noted  when  stimulating  living  muscles. 

5.  If  the  beating  heart  of  a  frog  is  removed  from 
the  latter,  and  placed  on  glass  or  a  board  and  brought 
in  immediate  contact  with  the  stomach-region  of  a 
subject,  dullness  of  the  stomach  is  at  once  elicited. 

166 


Physiological       Physics 

Thus,  with  an  exposure  of  one-half  minute  of  the 
beating  heart  to  the  stomach-region,  the  dullness  of 
the  stomach  will  persist  for  one-half  minute. 


F 


FIG.  42. — Apparatus  for  recording  stomach-contractions  incident  to 
the  action  of  transmitted  energy.  It  consists  of  a  stomach-tube  to  one 
end  of  which  a  rubber-balloon  is  fixed  and  to  the  other  end  a  pump  for 
inflating  the  balloon  in  the  stomach.  The  pump  and  stomach-tube  are 
connected  with  a  piece  of  V-glass  tubing.  The  stomach-contractions  are 
transmitted  to  a  tambour,  the  lever  of  which  makes  the  record  on  a  re-' 
volving  cylinder. 

6.  If,  say  a  leg-muscle  of  a  frog  is  removed  and 
then  divided  by  bringing  the  cut  surface  into  contact 
with  the  longitudinal  surface  of  the  muscle  a  number 
of  times  in  proximity  to  the  stomach-region  of  a 
subject,  dullness  of  the  stomach  is  at  once  elicited. 
The  force  thus  propagated  is  analogous  to  the  electric 
currents  from  muscles. 

367 


Progressive     Spondylotherapy 

7.  The  same  phenomenon  is  exhibited  by  metal 
(page  179)  and  plants. 

Thus,  if  the  stomach-region  is  brought  in  almost 
immediate  contact  with  a  growing  palm,  dullness 
of  the  stomach  ensues.  If,  a  leaf  from  a  living 
palm  is  severed  or,  if  the  transverse  cut  surface  is 
brought  in  contact  with  the  longitudinal  surface  of 
the  leaf  a  number  of  times  (in  proximity  to  the 
stomach),  the  same  phenomenon  of  dullness  is  ex- 
hibited as  when  a  muscle  removed  from  an  animal  is 
similarly  manipulated. 

The  effect  cited  by  the  maneuver  with  the  leaf  of 
the  palm  may  be  elicited  at  a  distance  of  5  feet  from 
the  patient  and  the  force  passes  through  a  sheet 
of  metal  held  in  front  of  the  stomach. 

The  transmission  of  psychic  force  is  discussed  on 
page  188. 

With  the  apparatus  shown  in  Fig.  42,  an  attempt 
was  made  to  make  a  record  of  the  stomach-contrac- 
tions with  the  results  shown  in  Fig.  43. 

The  effects  of  emotions  on  the  stomach-muscula- 
ture are  shown  in  Fig.  44. 

The  use  of  the  apparatus  for  making  these  records 
is  no  more  difficult  of  execution  than  making  records 
of  the  pulse. 

MISCELLANEOUS  EFFECTS. — It  is  difficult  in  the  ab- 
sence of  a  reflexometer  to  accurately  guage  the  action 
of  magnetization  and  demagnetization  on  the  reflexes. 

The  following  effects  are  however  apparent : 

1.  If  the  motor  area  of  the  brain  on  the  right  side 
is  demagnetized,  there  is  an  apparent  increase  of  the 
reflexes  on  the  opposite  side. 

2.  If  the  same  area  is  magnetized,  the  reflexes  on 
the  opposite  side  become  less  evident. 

Temperature. — If  the  temperature  of  the  body  is 

168 


Physiological      Physics 

below  normal,  exposure  of  the  individual  to  the  mag- 
netic flux  raises  the  temperature  one  degree  or  to  the 
normal. 


FIG.  43. — Tracings  of  the  stomach  with  the  apparatus  shown  in  fig-. 
42.  A,  normal  curves  dependent  on  respiratory  excursions;  B,  normal 
curves  due  to  transmitted  pulsations  of  the  aorta;  C,  curves  caused  by  con- 
cussion of  the  7th  cervical  spine;  D,  curves  caused  by  contraction  of  the 
stomach  due  to  making  and  breaking  of  the  current  leading  to  an  electro- 
magnet in  proximity  to  the  subject;  E,  curves  caused  by  transmitted 
energy  from  one  subject  (by  concussing  the  7th  cervical  spine)  to  an- 
other subject;  F,  curves  due  to  transmitted  psychic  energy  from  one  sub- 
ject to  another  subject.  During  the  making  of  records  C,  D,  E,  and  F, 
breathing  of  the  subject  from  whom  the  records  were  taken  was  tempor- 
arily suspended.  The  records  of  transmitted  energy  were  made  during 
the  time  one  subject  was  in  proximity  but  not  in  contact  with  the  other 
subject. 

To  express  this  matter  in  terms  of  greater  pre- 
cision one  instance  may  be  cited.  An  individual 
with  tuberculous  kidneys  shows  a  temperature  of 

169 


Progressive     Spo  ndy  1  o  th  er  apy 


96.2°  F.  He  is  then  placed  within  3  inches  (without 
contact)  of  a  powerful  electromagnet  (Fig.  32) 
for  a  period  of  3  minutes.  At  the  end  of  the  latter 
time,  the  thermometer  registers  98.6°  F. 

No    influence    is    noted   on    temperature    if    the 
latter  is  normal.  * 


FIG.  44. — Physiological  manifestations  of  the  emotions  as  exhibited  by 
contractions  of  the  stomach;  A,  joy;  B,  fear;  C,  great  agitation.  These 
tracings  were  taken  from  different  subjects  in  whom  these  emotions 
were  expressed  by  aid  of  the  apparatus  shown  in  fig.  42.  Practically  iden- 
tical records  were  made  in  other  subjects  under  like  emotional  conditions. 

In  my  investigations  it  has  been  noted  that, 
electrolysis  is  accentuated  by  the  magnetic  flux. 
This  may  easily  be  demonstrated  by  aid  of  a  solu- 
tion of  potassium  iodid.  The  brown  coloration 
(due  to  the  liberation  of  the  iodin)  is  more  intense 
with  than  without  the  magnetic  flux. 

Microbiology. — Notwithstanding  a  number  of 
investigations,  no  microbicidal  action  of  the  mag- 
netic force  could  be  demonstrated.  The  results  on 
photographic  plates  were  likewise  negative. 

Attempts  were  made  to  determine  whether  diges- 
tion was  facilitated  by  the  magnetic  force  and  re- 
tarded by  demagnetization  but  I  dare  not  venture  to 

170 


Physiological       Physics 

cite  my  results  for  the  reason  that  they  were  not 
conducted  over  a  sufficient  period  of  time  to  just- 
ify any  formulated  conclusions. 

Demonstration  of  stomach-border. — If  what  is 
known  as  a  triple  O  capsule  is  filled  with  ferrum  re- 
ductum  (reduced  iron),  and  well  covered  with  wax 
(to  prevent  its  solution  by  the  gastric  juice),  is  swal- 
lowed, its  location  may  be  determined  by  a  powerful 
electromagnet.  With  the  patient  standing,  the  tip  of 
the  magnet  is  placed  in  immediate  contact  with  the 
skin  of  the  abdomen  approximating  the  supposed  po- 
sition of  the  lower  border  of  the  organ. 

In  the  average  subject  (without  an  excess  of  ab- 
dominal fat),  when  the  current  of  the  magnet  is  on, 
the  capsule  may  be  seen  (and  felt)  to  approach  the 
tip  of  the  magnet  but  disappears  with  every  break  of 
the  current.  The  best  effects  are  noted  with  make 
and  break  of  the  current. 

The  capsule  is  best  located  outside  of  the  rectus 
muscle. 

The  impact  of  the  capsule  can  be  localized  by  the 
patient.  Making  and  breaking  the  current  during  the 
time  the  tip  of  the  magnet  is  moved  about  the  region 
of  the  stomach  is  another  method  of  localization. 

Another  method  is  to  have  the  patient  swallow  a 
soft  perforated  iron-capsule  about  the  size  of  the 
end  of  an  average  stomach-tube  and  connect  it  with 
rubber-tubing  of  small  caliber.  The  capsule  is 
better  attracted  if  it  has  been  previously  magnetized 
by  the  pole  opposite  to  that  which  is  used  for  at- 
traction. 

To  facilitate  the  localization  of  the  capsule,  a 
special  method  of  percussion  is  employed.  The 
finger  is  placed  not  on  but  just  above  the  skin  and 
then  struck  with  the  other  finger.  A  peculiar 
flopping  sound  is  heard  in  the  region  of  the  capsule. 

By  placing  the  tip  of  tbe  magnet  in  the  region  of 


Progressive     Spondylotherapy 

^3 

the  duodenum  during  the  time  pressure  is  made  at 
the  5th  dorsal  spine  (page  85),  the  capsule  can  be 
drawn  into  the  duodenum.  To  show  that  it  is  in 
the  latter  situation,  have  the  patient  drink  some 
colored  water.  If  the  capsule  is  in  the  duodenum, 
a  glass  syringe  attached  to  the  rubber-tube  will  as- 
pirate a  fluid  differing  in  color  from  the  ingested 
water. 


1Y2 


Deduction 


CHAPTER  X. 

DEDUCTIONS. 

HYPOTHESES — THE  REFLEX  NATURE  OF  MAN — TONICITT — ANI- 
MAL FORCE — LIFE — PROLONGATION  AND  REINFORCEMENT  OF 
REFLEXES— TOPOGRAPHIC  PERCUSSION— VISCERAL  ATTRAC- 
TION AND  REPULSION  —  NEUROSES SPLANCHNOPTOSIS  — 

PSYCHIC   FORCE — COLOR— POPULAR   QUESTIONS — SUMMARY. 

Hypotheses  are  essential  in  formulating  conclu- 
sions based  on  all  knowledge  concerning  scientific  in- 
vestigations. 

Prior  to  the  promulgation  of  the  Newtonian  hypo- 
thesis of  gravitation  and  the  laws  of  Kepler,  astron- 
omy was  in  a  hopeless  state  of  chaos. 

The  atomic  theory  in  chemistry  is  incapable  of 
demonstration  yet,  as  a  working  hypothesis,  it  has 
created  a  revolution  in  this  science.  The  fact  that  an 
hypothesis  is  only  demonstrable  by  its  results  in  no 
wise  compromises  its  value. 

Hudson,  observes,  "That  most  that  can  be  said  of 
any  scientific  hypothesis  is  that,  whether  true  in  the 
abstract  or  not,  everything  happens  just  as  though 
it  were  true.  When  this  test  of  universality  is  ap- 
plied, when  no  known  fact  remains  that  is  unex- 
plained by  it,  the  world  is  justified  in  assuming  it  to 
be  true,  and  in  deducing  from  it  even  the  most  mo- 
mentous conclusions."  The  author  is  fully  alive  to 
the  apothegm,  a  single  antagonistic  fact  militates 
against  the  value  of  the  most  ingenious  theory  ever 
evolved. 

A  careful  study  of  the  subject-matter  of  the  pre- 
ceding chapter  directs  attention  to  the  pertinent  fact 
that,  the  phenomena  cited  suggest  the  close  identity 
of  so-called  animal-force  with  the  various  forms  of 
force. 

173 


Progressive     Spondylotherapy 

Everything  tends  to  show  the  identity  of  the  vari- 
ous forms  of  force,  notably,  the  conservation  of  en- 
ergy, the  advances  in  the  study  of  radioactivity,  the 
kinetic  theory  of  gases  and  the  transmutation  of  elec- 
tricity into  heat,  light,  motion  or  chemical  energy. 

Selenium  changes  the  electrical  resistence  under 
the  influence  of  light.  In  its  crystaline  condition,  its 
sensitivity  to  light  is  increased  especially  to  green- 
ish-yelloiv  rays.  This  property  of  selenium  has  led 
to  the  construction  of  the  photophone. 

The  proof  adduced  by  the  author  concerns  chiefly 
the  phenomena  incident  to  the  elicitation  of  the  vis- 
ceral reflexes  and  the  tonicity  of  the  organs,  notably 
the  stomach. 

In  accepting  the  reflexes  as  demonstrative  evidence 
one  interrogation  seems  apposite:  Are  the  visceral 
reflexes  acknowledged  phenomena? 

For  many  years,  physiologists  have  been  able  to 
contract  and  dilate  organs  in  vivisected  animals  by 
stimulating  definite  nerves  of  the  spinal  cord.  What 
the  physiologist  has  done  in  the  laboratory  has  been 
successfully  attained  by  the  author  in  the  living  hu- 
man. 

In  189816,  the  writer  first  demonstrated  by  aid  of 
the  X-rays  what  are  now  known  in  the  literature  as 
the  "  heart  reflexes  of  Abrams."  The  latter  signify 
contraction  or  dilatation  of  the  heart  incident  to  stim- 
ulation of  definite  regions  of  the  spinal  cord. 

After  this,  a  large  number  of  his  eponymic  reflexes 
were  discovered  and  his  observations  have  been  con- 
firmed by  some  of  the  leading  clinicians  of  the  world. 

Man  is  essentially  a  reflex  animal  (page  5).  The 
phenomena  of  vegetative  life,  respiration,  circulation, 
nutrition,  etc.,  are  produced  in  the  subconscious  state, 
and  without  voluntary  effort.  Consciousness  is  not 

174 


Deductions 

co-extensive  with  mind  and  the  work  of  mentality  can 
be  accomplished  without  consciousness,  just  as  the 
machinery  of  a  clock  might  work  without  a  dial. 

Man  portrays  his  automicity  in  his  reflexes  and  the 
latter  are  controlled  by  a  force  over  which  he  can  ex- 
ercise no  conscious  control. 

The  dead  birds  found  about  light-houses  are 
drawn  by  the  glare  to  strike  against  the  heavy 
panes.  The  moth  flies  straight  for  a  flame  and  if 
the  pushing  effect  of  the  heat  balances  the  attract- 
ive force  of  the  light,  it  will  circle  the  flame.  A 
flower  in  a  room  will  direct  its  petals  towards  the 
fight 

The  reflex  acts  of  the  birds  and  moths  differ 
in  no  respect  from  the  reflex  acts  of  the  flower. 
The  same  force  is  dominant. 

Even  though  the  author  vaticinates  the  skeptic  re- 
ception which  will  at  first  be  accorded  to  his  ob- 
servations, he  could  not  possibly  have  relinquished 
the  many  toilsome  though  delightful  hours  which  he 
has  devoted  to  a  study  of  this  subject.  The  force 
which  inspired  his  instinctivity  differed  in  no  re- 
spect from  that  which  activates  the  work  of  the  ant 
or  the  bee. 

TONICITY. — The  contractility  of  the  stomach-mus- 
culature and  the  transition  of  tympanitic  resonance 
to  dullness  on  percussion  was  also  adduced  as  proof 
of  the  identity  of  the  various  forms  of  force. 

Tonicity  has  already  been  discussed  CPaSes  6  and 
124).  Muscle  in  a  state  of  tension  which  is  practi- 
cally its  tonus  is  a  conspicuous  example  of  living 
matter.  In  consequence  of  this  tension,  the  efficiency 
of  the  stomach  as  a  motor  organ  is  increased.  Muscle- 
tonus  is  a  reflex  and  is  caused  by  stimuli  acting  on  the 
skin  (and  elsewhere)  conveyed  by  nerves  to  the  cord 
and  from  the  latter,  impulses  are  carried  to  the  mus- 
cles. This  tonus  disappears  if  either  the  posterior 

175 


Progressive     Spondylotherapy 

roots  of  the  spinal-nerves  or  the  afferent  nerves  from 
the  muscle  are  cut. 

Important  functions  of  tonicity  are  the  production 
of  heat  and  the  maintenance  of  metabolism. 

ANIMAL-FORCE. — The  actual  connection  between 
magnetism  and  currents  of  electricity  was  not  defi- 
nitely determined  until  1820,  when  Oersted,  publish- 
ed the  fact  that  a  magnetic  needle  is  disturbed  by  the 
presence  of  an  electric  current  in  its  neighborhood. 

Magnetism  set  up  by  an  electric  current  is  known 
as  electromagnetism. 

There  is  no  difference  in  the  magnetic  force  pro- 
duced by  a  permanent  magnet  and  that  produced  by 
an  electric  current.  The  magnetic  field  surrounding 
the  flowing  current  consists  of  a  kind  of  magnetic 
whirl  and  is  strongest  nearest  the  current. 

Investigations  concerning  animal  electricity  began 
with  the  famous  experiment  of  Galvani,  in  1786,  who 
observed  contraction  of  the  frog's  thigh  when  touch- 
ed in  two  places  with  the  ends  of  a  metallic  arc.  This 
discovery  led  physiologists  at  that  time  to  believe  that 
the  vital  force  was  at  last  discovered. 

Notwithstanding  Volta's  observation  that,  the  con- 
tractions were  caused  by  the  dissimilarity  of  the  two 
ends  of  the  metal  touching  the  moist  conductor  and 
upon  the  production  thereby  of  a  Galvanic  arc,  later 
investigation  demonstrated  that  electrical  differences 
of  potential  do  occur  in  the  animal  body. 

In  every  active  nerve  or  muscle  electrical  currents 
are  produced,  and  the  latter  are  intimately  associated 
with  the  functional  condition  of  the  tissue.  Every 
active  part  maintains  a  negative  electrical  relation 
toward  the  part  at  rest. 

Elecrical  phenomena  are  encountered  in  other  tis- 
sues and  in  plants. 

176 


Deductions 

If  a  shaded  and  exposed  part  of  a  green  leaf  be  con- 
nected with  a  Galvanometer,  an  electric  current  is  de- 
veloped when  the  light  falls  on  the  exposed  part. 

The  electrical  organs  of  electrical  fishes  are  essen- 
itally  metamorphosed  muscles  and  the  force  of  the 
electric  current  in  the  cramp  fish  amounts  to  31  volts. 

For  many  years,  the  subject  of  animal  electricity 
was  in  disrepute  owing  to  the  charlatanry  associated 
with  it,  but  thanks  to  its  scientific  investigation  by 
physiologists,  notably,  Du  Bois-Reymond  and  Her- 
mann, it  was  partially  rescued  from  evil. 

It  is  questionable  whether  animal-magnetism  is  de- 
rived wholly  from  animal  electricity  or  the  earth's 
magnetism  or  whether  both  are  concerned  in  its  pro- 
duction. The  theory  of  Ampere,  supposed  that  the 
cause  of  the  earth's  magnetism  was  due  to  currents 
of  electricity  flowing  around  the  earth. 

One  may  conceive  the  sun  as  a  gigantic  cathode 
negatively  charged  giving  off  corpuscles  like  all  in- 
candescent bodies.  These  corpuscles  coming  under 
the  influence  of  the  earth's  magnetism  travel  along 
the  line  of  the  earth's  magntic  force.  It  is  even  prob- 
able that  the  corpuscles  whirling  about  on  their  own 
axes  create  a  magnetic  field  in  their  vicinity. 

It  is  reasonable  to  assume  that,  the  molecules  of  an- 
mal  tissues  are  inherently  or  naturally  magnetized; 
each  molecule  showing  a  north  and  south  polarity. 
This  polarity  may  be  caused  by  closed  circuits  of  ani- 
mal electricity  or  from  the  magnetic  flux  in  the  at- 
mosphere. 

In  the  act  of  magnetization,  like  poles  face  in  the 
same  direction  (Fig.  31).  We  may  further  assume 
that  every  electrified  molecule  is  a  magnet  with  vary- 
ing degress  of  magnetic  force  and  what  is  known  as 
chemical  affinity  is  nought  else  but  the  magnetic 
properties  of  molecules. 

177 


Progressive     Sp  o  ndy  1  o  th  er  apy 

Energy  is  essentially  the  mechanics  of  the  ether 
and  force  is  anything  which  moves  matter. 

LIFE. — Scientists  are  disposed  to  group  the  natural 
sciences  into  the  biological  sciences  dealing  with  liv- 
ing things  and  the  abiological  or  physical  sciences 
dealing  with  lifeless  matter. 

It  was  a  great  concession  when  the  vital  phenome- 
na of  animals  and  plants  were  studied  equally  with 
man  in  determining  the  field  of  life. 

Of  all  vital  phenomena,  motion  furnishes  the  most 
suggestive  impression  of  living.  Thus,  a  child  would 
regard  a  steam  engine  as  a  living  thing. 

The  conception  of  life  has  always  varied  with  the 
development  of  the  human  species.  The  primitive 
conception  was  associated  with  the  wind,  waves,  fire, 
in  fact  with  anything  in  motion. 

Vital-force  was  primarily  employed  to  signify  a 
mystical  power  resident  in  the  living  and  differing 
from  electric,  thermic  and  other  forms  of  energy. 

At  present,  vital-force  signifies  energies  resident  in 
living  matter. 

The  hypothesis  of  vitalism,  supposed  that  the  phe- 
nomena of  life  are  inexplicable  apart  from  a  special 
vital-force  resident  in  organisms  and  different  from 
the  chemico-physical  energies  of  the  inanimate  world. 

The  neo-vitalists  maintained  that  it  was  impossible 
to  furnish  a  complete  chemico-physical  restatement 
of  any  observed  function. 

Vitality  was  a  complex  adaptive  synthesis  of  mat- 
ter and  energy,  the  secret  of  which  was  unknown. 
Foster  contended  that  what  we  call  structure  and 
composition  must  be  approached  under  the  dominant 
conceptions  of  modes  of  motion.  The  qualities  of  liv- 
ing matter  are  expressions  of  internal  movements. 

Our  present  conception  of  vital  phenomena  (in  ani- 
mals and  plants)  refers  the  vital  energy  to  a  single 

178 


Deductions 

inorganic  force  drawn  from  the  sun.  The  sun  is  an 
inexhaustible  source  of  physical  energy  and  main- 
tains the  activity  of  all  living  things.  The  forces 
which  exist  in  nature  may  be  transformed  but  not 
created  by  living  things. 

The  forces  of  organic  and  inorganic  matter  are 
identical. 

The  distinguished  Calcutta  physicist,  Bose,  be- 
lieves that  in  some  obscure  degree,  all  matter  lives. 
It  is  difficult  to  distinguish  a  dividing  line  between 
the  animate  and  inanimate.  Bose,  regards  as  a  true 
test  of  life  in  an  object,  its  capacity  to  respond  to  an 
external  stimulus — L  e.,  its  irritability  or  sensitive- 
ness. Iron  is  as  irritable  as  the  human  body  as 
'  shown  by  a  galvanometer.  Metals  have  periods  of 
activity  and  rest  like  animal  matter ;  they  show 
curves  of  fatigue  when  stimulated  excessively,  and 
stimulants  and  narcotics  have  an  action  on  metals 
similar  to  that  observed  in  living  animal  matter. 
The  forces  emanating  from  chemical  reactions  and 
metal  show  the  same  action  as  the  force  discharged 
from  the  organism. 

Dissolving  common  salt  in  a  vessel  of  water  or 
striking  steel  with  a  hammer  in  proximity  to  the 
stomach-region,  will  at  once  evoke  a  transitory  area 
of  stomach-dullness.  With  the  salt  undergoing  so- 
lution a  tremendous  force  is  developed  (page  181). 
Striking  the  steel  mechanically  agitates  it  and  de- 
magnetizes it.  Why  a  few  strokes  of  the  hammer 
causes  the  greater  part  of  the  magnetism  to  dis- 
appear cannot  be  accounted  for  by  physicists  but  in 
the  light  of  my  investigations  it  would  appear 
to  be  caused  by  a  discharge  of  force  from  the  metal. 
To  avoid  air-concussion,  the  metal  was  struck  with 
a  rubber  hammer. 

Life  is  dependent  on  external  conditions  of  the 
earth's  surface  and  is  in  a  sense  a  function  of  the  de- 
velopment of  the  earth.  In  the  ceaseless  and  intricate 
dance  of  the  molecules  constituting  living  matter, 
the  question  of  personal  identity  must  be  considered. 

179 


Progressive     Spondylotherapy 

Matter  is  essential  to  consciousness.  Matter  changes 
constantly  but  consciousness  shows  no  solution  of  con- 
tinuity. As  one  writer  observes, ' '  Constancy  of  form 
in  the  grouping  of  the  molecules,  and  not  the  con- 
stancy of  the  molecules  themselves,  is  the  correlative 
of  this  constancy  of  perception." 

There  is  no  reason  to  question  the  belief  that,  if  one 
could  gather  the  molecules  and  put  them  in  the  same 
relative  positions  which  they  occupy  in  the  organism 
and  endow  them  with  identical  forces  and  distribution 
of  forces  and  motions  and  distribution  of  motions, 
this  organized  molecular  concourse  would  constitute 
a  sentient  thinking  being. 

Identity  is  no  less  an  attribute  of  inorganic  than  it 
is  of  organic  matter. 

The  property  of  assuming  more  than  one  elemen- 
tary form  is  known  in  chemistry  as  allotropism.  The 
diamond,  graphite  and  amorphous  carbon  are  identi- 
cal in  composition  although  showing  different  prop- 
erties. Here  identity  is  not  only  a  question  of  a  dif- 
ference of  the  number  of  atoms  in  a  molecule  but  a 
difference  in  the  arrangement. 

When  crystals  of  urea  were  first  discovered  in  the 
body  they  were  regarded  as  products  of  vital  energy 
but  this  theory  was  exploded  when  urea  was  formed 
outside  of  the  body  by  synthesis. 

Scientists  recognize  a  law  of  change  and  a  law  of 
continuity.  They  deal  with  energy  which  is  neither 
created  nor  destroyed.  Respecting  mentality  at  death, 
we  do  not  know  what  part  of  the  cosmos  takes  it  up. 
The  latter  is  a  problem  of  psychology. 

The  chemic  theory  of  Pflliger  suggests  that  the  real 
difference  between  dead  and  living  proteid  lies  in  the 
grouping  of  the  nitrogen  in  the  molecule. 

In  the  physics  of  life,  the  origin  of  energy  predi- 

180 


Deductions 

cates  an  understanding  of  the  law  of  the  conserva- 
tion of  energy.  .  Chemic  action  is  demonstrated  by 
different  forms  of  energy;  it  may  be  heat,  light  or 
electricity.  A  chemic  reaction  is  not  only  a  rear- 
rangement of  matter,  but  also  a  transformation  of 
energy. 

The  epoch-making  researches  of  Loeb,  suggested 
the  identity  of  electricity  and  vitality. 

Common  salt  dissolved  in  water  makes  the  latter 
a  conductor  of  electricity. 

Arrhenius,  demonstrated  that  by  this  solution 
the  molecules  are  torn  asunder  with  an  enormous 
electrical  charge  on  the  atoms  (one  set  being  pos- 
itively and  the  other  set  negatively  charged). 

The  electrically  charged  atoms  are  known  as  ions. 
In  the  contraction  of  a  muscle,  the  negatively 
charged  atoms  start  the  contraction  and  the  posit- 
ively charged  atoms  arrest  it. 

The  chief  value  of  food  is  to  produce  electricity ; 
heat  and  other  objects  are  of  secondary  importance. 

In  deducing  from  the  observations  of  the  preceding 
chapter  concerning  the  force  concerned  in  vital  phe- 
nomena, we  are  constrained  to  conclude  that  it  is  an 
electromagnetic  force.  Whether  the  electromagnetic 
force  is  derived  from  animal  electricity  or  the  latter 
is  of  magnetic  origin  is  a  mere  question  of  logomachy. 

Before  the  time  of  Oersted,  the  intimate  relations 
of  electricity  and  magnetism  were  not  recognized  and 
until  the  time  of  Faraday,  it  was  impossible  to  con- 
ceive of  the  enormous  storage  of  electricity  from 
spinning  magnets. 

In  accordance  with  Ampere's  theory  of  magnetism, 
which  may  be  paraphrased  with  specific  reference  to 
the  organism,  one  may  regard  the  animal  tissues  as 
molecular  magnets  around  which  an  electric  current 
is  continually  flowing.  In  other  words,  the  molecules 

181 


Progressive     Sp  o  ndyl  o  therapy 

of  tissues  are  nought  else  but  rotating  portions  of 
electrified  matter  (Fig.  45.) 

In  the  study  of  all  vital  phenomena,  the  cell  must 
be  regarded  as  an  elementary  organism.  It  is  the  be- 
ginning and  source  of  the  entire  body.  It  is  the  pri- 
mary anatomic  and  physiologic  unit  of  the  organic 
world.  The  essential  constituent  of  the  cell  is  bio- 
plasm, the  characteristics  of  which  have  already  been 
discussed  on  page  126. 


FIG.  45. — Illustrating  Ampere's  theory  of  magnetism.  Each  molecule 
has  a  current  of  electricity  circulating  round  it.  This  figure  represents 
the  N-seeking  pole  and  the  currents  move  in  the  direction  opposite  to 
that  of  the  hands  of  a  watch  (after  Poyser.) 

We  have  noted  that  the  magnetic  force  will  repro- 
duce the  phenomena  of  bioplasm  and  in  this  action  it 
is  superior  to  all  the  other  forces  employed  in  our  in- 
vestigations. In  assigning  to  electro-magnetic  force 
the  source  of  vital  energy,  we  dare  not  deny  the  trans- 
mutation of  the  various  forms  of  force. 

PROLONGATION  OF  REFLEXES. — It  has  already  been 
shown  (page  125)  that  the  magnetic  force  will  pro- 
duce reflexes  lasting  for  many  hours.  In  this  respect 
other  known  forces  in  comparison  are  relatively 
inert  in  action.  This  prolongation  of  the  reflexes  is 
equivalent  to  the  supply  of  tone  (page  124). 

REINFORCEMENT  OF  REFLEXES. — Reading  of  the  sub- 
ject matter  on  page  40,  will  elucidate  the  purport  of 

182 


Deductions 

this  caption.  The  magnetic  force  may  be  employed  in 
lieu  of  the  mechanic  methods  cited.  When  a  subject 
is  exposed  to  the  flux  in  a  magnetic  field,  the  organism 
displays  its  specific  attribute  of  selection ;  the  sympa- 
thetic-fibers and  vagus-fibers  appropriating  an 
amount  sufficient  for  their  individual  use.  If,  how- 
ever, one  charges  the  vagus-nerve  at  the  7th  cervical 
spine,  this  power  of  selection  is  defeated  and  the  tone 
acquired  by  the  vagus-fibers  will  be  in  physiologic 
excess  of  the  inherent  force  present  in  the  sympa- 
thetic nervous  system. 

Life,  said  Sir  Thomas  Browne,  "is  a  pure  flame 
and  we  live  by  an  invisible  sun  within  us." 

.  The  organism  may  be  regarded  as  an  animal  ma- 
chine. Ostwald  speaks  of  a  benzine  motor  which 
regulates  its  benzine-supply  by  means  of  a  ball- 
governor  in  such  a  way  that  its  velocity  remains 
constant,  as  having  exactly  the  same  property 
as  a  living  organism.  If  such  a  machine  could  work 
constantly  and  could  receive  an  inexhaustible  supply 
of  benzine,,  we  would  be  compelled  to  regard  it  as  a 
living  organism. 

In  our  mechanistic  conception  of  life,  we  fail  to 
pay  due  regard  to  the  regulatory  mechanism  of  the 
organism  by  which  it  regulates  its  supply  of  force 
(as  expressed  in  tissue-tone)  and  what  physiolo- 
gists call  force.  The  selective  attribute  of  supply- 
ing and  discharging  force  to  the  organs  is  probably 
mediated  by  the  autonomic  system  (page  25).  If 
during  the  time  this  system  is  demagnetized  (at  the 
7th  cervical  spine),  it  is  impossible  with  the  most 
powerful  electromagnetic  flux  to  elicit  any  stomach- 
dullness  ;  i.  e.,  no  tone  can  be  imparted  to  the  stom- 
ach or  for  that  matter  to  any  of  the  other  organs. 

It  is  not  unlikely  that,  the  sympathetic  system  is 
purely  negative  in  action  like  the  vasodilator  nerves 
(page  64)  ;  its  activity  only  becoming  manifest 
when  the  force  resident  in  the  autonomic  system 
becomes  diminished.  At  any  rate,  force  as  a  factor 
in  the  animal  machine  is  an  important  one. 

183 


Progressive     Spondylotherapy 

TOPOGRAPHIC  PERCUSSION. — Augmenting  the  supply 
of  tone  to  the  organs  by  increasing  the  rigidity  of 
their  muscular  components  will  yield  a  more  pro- 
nounced dullness  on  percussion  (page  150).  After 
this  manner  we  may  delimit  the  organs  in  a  manner 
almost  equivalent  to  their  delimination  by  the  X-rays 
without  any  of  the  errors  or  inconvenience  incident 
to  the  use  of  the  latter.  To  attain  these  results,  all 
that  is  necessary  is  to  have  the  patient  stand  in  prox- 
imity to  the  source  of  the  magnetic  force. 

In  this  respect,  either  pole  is  sufficient.  In  the 
absence  of  a  large  electromagnet,  one  may  fix  an  ordi- 
nary horse-shoe  magnet  in  the  center  of  the  organ 
which  is  to  be  delimited  (Fig.  36).  The  right  border 
of  the  heart  which  is  conceded  to  be  difficult  to  delimit 
is  readily  outlined  provided  percussion  is  executed  at 
the  end  of  a  forced  expiration. 

VISCERAL  ATTRACTION  AND  REPULSION  (page  156). — 
No  conclusions  have  been  formulated  respecting  these 
phenomena  exhibited  by  the  organs  in  morbid  condi- 
tions. Sufficient  data  however,  have  been  accumulated 
to  show  that  further  investigations  will  furnish  im- 
portant facts  concerning  this  subject. 

Drugs  have  an  important  influence  on  the  phe- 
nomena in  question  (page  159).  In  hysteria,  asa- 
fetida,  valerian  and  allied  drugs,  have  been  found 
empirically  to  possess  a  remarkable  sedative  action. 
Such  effects  have  never  been  explained  other  than 
by  saying  that,  all  malodorous  drugs  are  grateful 
to  hysterics. 

In  hysteria,  I  have  found  that  the  organs  show 
little  or  no  magnetic  attraction  but  after  adminis- 
tering a  drug  like  valerian  the  attraction  is  aug- 
mented ;  that  is  to  say,  the  liver  will  be  found  to 
descend  lower  after  than  before  the  administration 
of  this  drug. 

184 


Deductions 

TRAUMATIC  NEUROSES. — After  accidents,  symptoms 
of  neurasthenia  or  hysteria  or  both  develop.  The  con- 
dition is  often  known  as  "railway  brain"  or  "railway 
spine. ' '  As  a  rule  there  is  no  anatomic  change  pres- 
ent to  account  for  the  symptoms.  It  has  been  shown 
on  page  157,  that  concussion  of  the  vertebrae  is  equiv- 
alent to  demagnetization  but  whether  the  latter  has 
any  bearing  on  the  condition  is  a  matter  for  further 
investigation. 

Mere  concussion  of  an  organ  like  the  liver  will  not 
only  prevent  its  descent  by  an  electromagnet  (page 
156)  but  will  actually  cause  its  repulsion,  i.  e.,  percus- 
sion shows  a  rise  of  the  lower  border  of  the  organ. 

SPLANCHNOPTOSIS. — Many  ingenious  theories  have 
been  suggested  to  account  for  prolapse  of  the  abdom- 
inal organs.  Among  the  theories  are: 

1.  Pathologic  reversion  of  the  location  of  the  ab- 
dominal organs  to  an  embryonic  state; 

2.  The  abdominal  organs  are  supported  by  liga- 
ments and  when  the  firmness  and  rigidity  of  the  latter 
are  impaired  the  equilibrium  of  the  organs  is  disturb- 
ed.   This  theory  is  defective  for  the  reason  that,  all 
the  ligaments  in  the  abdomen  are  insufficient  to  sup- 
port even  the  liver ; 

3.  The  abdominal  organs  are  kept  in  place  by  in- 
tra-abdominal  pressure. 

4.  The  organs  are  kept  in  position  by  negative  as- 
piration of  the  thorax ; 

5.  The  position  of  the  organs  is  maintained  by 
pressure  and  ligaments ; 

6.  The  organs  are  maintained  in  position  by  the 
normal  tone  of  their  muscular  tissue  (page  8). 

The  author  finds  that  the  latter  theory  is  probably 
the  correct  one  as  can  be  demonstrated  by  the  f  ollow- 

185 


Progressive     Spondylotherapy 

ing  investigations.  If  one  demagnetizes  (which  is 
equivalent  to  the  abstraction  of  tone)  the  region  cor- 
responding to  the  7th  cervical  spine,  tone  is  removed 
from  the  pneumogastric  nerve  which  supplies  the 
abdominal  organs.  In  consequence  of  this  loss  of 


FIG.  46. — Illustrating  a  fall  of  the  organs  (aorta,  heart  liver,  spleen 
and  stomach)  after  removal  of  vagus-tone  by  demagnetization  at  the  7th 
cervical  spine.  The  broken  lines  indicate  the  position  of  the  lower  bor- 
ders (excepting  heart  and  aorta)  before  and  the  continuous  lines  after 
demagnetization. 

tone  or  energy,  there  is  an  immediate  drop  of  the 
liver,  stomach  and  spleen  (Fig.  46).  A  more  decided 
drop  is  noted  if  demagnetization  is  executed  over  the 
region  of  the  heart.  The  latter  is  probably  the  chief 
source  of  the  energy  of  the  organism  (page  164).  In 
consequence  of  the  latter  maneuver,  the  heart  likewise 
drops.  If  one  now  charges  the  vagus  with  magnetic 
force  at  the  7th  cervical  spine,  the  organs  at  once 
resume  their  former  position. 

186 


Deductions 

It  has  already  been  shown  (page  154)  that  mag- 
netic force  only  fixes  but  does  not  raise  normal  vis- 
cera, hence,  by  this  method  we  have  a  simple  means 
of  determining  the  presence  of  prolapsed  organs. 
If,  by  charging  the  7th  cervical  spine,  any  organ  rises 
in  position,  it  must  have  been  prolapsed. 

Demagnetization  attempted  over  the  liver  or  spleen 
causes  only  a  descent  of  the  liver  or  the  spleen. 

If  one  demagnetizes  between  the  3rd  and  4th  dorsal 
spines,  the  tone  of  the  vagus  is  no  longer  counter- 
acted by  the  tone  of  the  sympathetic  nerves  (page 
161)  and  the  organs  occupy  a  higher  position  than 
when  the  magnetic  force  is  conveyed  to  the  vagus  at 
the  7th  cervical  spine. 

The  behavior  of  the  kidneys  was  quite  contrary 
to  my  expectations.  Demagnetization  at  the  7th 
cervical  spine  causes  a  rise  in  the  position  of  the 
kidneys  and  a  contrary  effect  when  demagnetization 
is  executed  between  the  3rd  and  4th  dorsal  spines. 
It  is  possible  that  although  the  normal  position  of 
the  other  organs  is  dominated  by  the  vagus,  the 
sympathetic  influences  the  normal  position  of  the 
kidneys. 

Forc'e  of  the  heart. — Electrical  variations  to  the 
contractions  of  the  heart  (Fig.  47)  may  be -deter- 
mined by  electrocardiagrams.  Here,  the  contraction 
of  a  ventricle  is  comparable  with  a  simple  muscular 
contraction  (page  165). 

The  hands  of  the  patient  are  immersed  in  jars 
containing  0.9  per  cent  of  sodium  chlorid  solution. 
The  jars  are  connected  in  circuit  with  a  very  deli- 
cate Einthoven  thread-galvanometer  and  the  move- 
ments of  the  latter  are  recorded  photographically. 
This  apparatus  is  chiefly  employed  in  detecting  ir- 
regularities in  the  rhythm  of  the  heart. 

187 


Progressive     Spondylotherapy 

An  important  avenue  of  study  consists  in  deter- 
mining the  force  of  the  heart  by  the  method  indicated 
on  page  166.  Here,  force  may  be  calculated  by  the  in- 
tensity and  duration  of  dullness  plus  the  distance 
from  the  subject  in  whom  dullness  of  the  stomach  is 
evoked. 

PSYCHIC  FORCE  AND  ITS  TRANSMISSION. — On  page 
165,  reference  was  made  to  definite  facts  concerning 
action-currents. 

The  following  investigations  show  that  the  psychic 
action-currents  conform  to  like  laws. 


FIG.  47. — Showing  variations  of  electrical  potential  associated  with 
the  beat  of  the  human  heart  and  their  distribution  n  the  body  (after 
Waller).  These  electrical  currents  generated  by  the  activity  of  the  heart 
diffuse  throughout  the  entire  body  according  to  the  usual  laws. 

The  action-current  is  associated  with  the  process  of 
excitation  and  is  produced  by  all  kinds  of  stimuli  but 
varies  in  strength  with  the  strength  of  stimulation. 

1.  If  one  side  of  the  head  of  a  subject  is  struck  a 
series  of  blows  by  means  of  a  rubber  hammer,  a  stom- 
ach-dullness in  the  subject  ensues.  Here  a  force  is 
generated  not  unlike  that  evoked  by  striking  the  7th 
cervical  spine  (page  164). 

188 


D 


u 


t 


0 


n 


2.  If,  however,  the  blows  are  struck  on  both  sides 
of  the  head  of  the  subject,  no  stomach- dullness  can  be 
elicited.  The  two  negative  currents  apparently  gener- 
ated neutralize  the  production  of  psychic  force.  Con- 
cussion of  the  head  in  the  median  line  is  likewise 
negative. 

3.  If,  while  sitting  in  proximity  to  the  exposed 
stomach-region  of  the  first  subject  and  one  side  of  the 
head  of  another  subject  is  concussed,  a  stomach-dull- 
ness can  be  elicited  in  the  first  subject.    Such  dullness 


R/ghr  3/cfe, 


FIRST    SUBJECT 


Left  6/c/e 


SECOND    SUBJECT 


FIG.  48. — Illustrating  positive  and  negative  reactions  on  the  stomach 
musculature  by  stimulating  like  and  unlike  sides  of  two  subjects. 

however,  is  not  evoked  if  the  head  of  the  second  sub- 
ject is  concussed  in  the  median  line  or  first  on  one 
and  then  on  the  other  side. 

If  subject  one  is  faced  by  subject  two  and  the  right 
or  left  side  of  the  head  of  both  subjects  is  simultane- 
ously concussed,  no  stomach  dullness  ensues.  If,  how- 
ever, opposite  sides  of  the  head  of  both  subjects  are 
concussed,  dullness  ensues.  A  similar  phenomenon  is 

189 


Progressive     Spondylotherapy 

noted  when  the  arms  of  both  subjects  are  voluntarily 
contracted  (Fig.  48). 

This  experiment  suggests  that  our  bodies  may 
be  likened  to  a  horseshoe  magnet,  positively 
charged  on  one  side  and  negatively  charged  on  the 
other  side.  Further,  that  the  circumambient  ether 
in  proximity  to  our  bodies  is  similarly  polarized. 
In  accordance  with  the  law  of  attraction  and  repul- 
sion (page  138),  the  positive  and  negative  reactions 
in  the  foregoing  experiments  may  be  explained. 

Electrotaxis  illustrates  this  attraction  and  repul- 
sion. If  a  Galvanic  current  is  allowed  to  flow 
through  a  trough  filled  with  water  and  containing 
animals,  the  latter  move  in  the  direction  of  either 
the  positive  or  of  the  negative  current. 

4.  These  maneuvers  are  negative  with  moderate 
electric  stimulation. 

5.  If  during  the  time  the  center  of  the  head  is  be- 
ing demagnetized,  concussion  on  either  side  of  head  is 
negative  with  reference  to  the  elicitation  of  dullness. 
If,  however,  only  one  side  of  the  head  is  demagnet- 
ized, concussion  of  the  other  side  elicits  the  stomach- 
dullness.  If  demagnetization  is  executed    over    the 
region  of  the  heart,  concussion  of  the  head  is  negative 
in  revealing  stomach-dullness. 

The  probable  source  of  the  force  in  the  organism  is 
from  the  heart. 

6.  Thought  yields  a  force  the  presence  of  which 
can  be  exhibited  ~by    stomach-dullness.    This    force 
however,  is  not  revealed  if  the  brain  functionates  in 
its  entirety  unless  a  special  maneuver  is  tried.    It  is 
necessary  to  demagnetize  one  side  of  the  brain  during 
the  time  of  thought.    In  demagnetizing,  it  is  not  nec- 
essary to  reduce  the  intensity  of  the  current  (page 
160)  ;  the  mere  change  of  polarity  suffices.    The  best 
effects  are  noted  when  the  rod  of  the  demagnetizing 
instrument  is  placed  on  the  side  of  the  frontal  region. 

190 


Deductions 

With  the  first  subject  in  one  room  with  closed  doors 
and  the  other  subject  in  another  room,  the  force  pro- 
voked by  thought  may  be  transmitted  from  the  latter 
to  the  former  over  a  distance  of  forty  or  more  feet  as 
revealed  by  stomach-dullness  in  the  first  subject. 
Psychic  force  passes  through  metal  and  all  other 
media  thus  far  tried. 

Anger  and  emotions  yield  a  force  which  may  be 
transmitted  over  a  distance  of  eighty  feet. 

The  potentiality  of  the  psychic  force  is  determin- 
able  by  the  intensity  and  duration  of  the  stomach- 
dullness  and  the  distance  of  the  subject  from  the  per- 
son engaged  in  thought.  The  position  of  the  recipi- 
ent with  reference  to  the  person  occupied  in  thought 
is  of  no  moment  but  the  recipient  must  be  standing  to 
elicit  the  reaction  of  stomach  dullness. 

In  my  experiments,  the  person  engaged  in  thought 
was  instructed  to  pe/f  orm  examples  in  mental  arith- 
metic. 

The  Cartesian  conception  that,  matter  cannot  act 
where  it  is  not,  was  overthrown  by  Newton,  in  his  law 
of  universal  gravitation. 

7.  COLOR  influences  the  transmission  of  psychic 
force  as  can  be  noted  when  the  person  engaged  in 
thought  holds  large  clored  sheets  of  gelatine  in  front 
of  the  head.  Green  and  violet  obstruct  the  passage 
of  the  force  whereas  blue  and  notably  yellow  inten- 
sify the  action  of  the  force  as  revealed  by  the  inten- 
sity and  duration  of  the  stomach-dullness.  Light  act- 
ing on  the  head  through  a  yellow  medium  minimizes 
psychic  activity  (page  200). 

Some  writers  work  better  in  proportion  as  the 
heat  and  light  are  more  intense.  Some  cannot  think 
well  in  the  dark.  Red  excites  some  individuals  and 
most  animals.  Witness  the  matador  as  he  excites 
the  infuriated  bull  to  charge  by  manipulations  of  his 
red  cloth. 

There  is  reason  for  the  foregoing.    Electric  light 

191 


Progressive     Spondylotherapy 

thrown  on  one  side  of  the  head  stimulates  like 
a  blow  and  excites  the  stomach  to  contract.  Directed 
on  the  center  of  the  head,  it  is  negative.  Light 
passed  through  a  red  medium  covering  the  head 
is  negative  when  directed  on  one  side  of  the  head 
but  produces  a  powerful  contraction  when  directed 
on  the  center  of  the  head. 

This  exciting  effect  on  protoplasm  is  the  same 
whether  resident  in  muscle  or  brain. 

Psychic  force  may  be  transmitted  to  another  (as 
revealed  by  stomach-dullness),  if  during  thought,  the 
head  is  covered  (covering  other  parts  does  not  suf- 
fice) with  some  red  material  or,  if  the  latter  is  held  in 
front  of  the  stomach  of  the  second  subject. 

This  experiment  dispenses  with  the  necessity  of  de- 
magnetising one  side  of  the  head.  Furthermore,  the 
stomach  of  the  patient  engaged  in  thought  may  be 
used  provided  any  red  material  is  thrown  over  the 
head  or  held  near  the  stomach-region.  If  red  paper  or 
any  other  red  material  is  thrown  over  the  head  of  an 
intelligent  dog,  the  stomach  of  a  subject  in  proximity 
to  the  animal  shows  dullness  and  the  latter  disappears 
when  the  colored  material  is  removed.  The  force  thus 
transmitted  differs  in  no  respect  from  the  psychic 
force  of  the  human  as  far  as  its  physiologic  effects  is 
concerned. 

The  foregoing  experiments  may  explain  some  of 
the  phenomena  of  telepathy.  Thought-transference  is 
a  reality  despite  the  fact  that  the  most  we  know  about 
it  is  that  we  know  nothing  about  it  and  are  not  sure 
even  of  that. 

The  proceedings  of  the  "Society  for  Psychical  Re- 
search," reveal  many  pertinent  paradigms  which 
demonstrate  that  in  man  there  is  a  faculty  which  per- 
mits him  at  times  to  communicate  directly  with  the 
consciousness  of  another  individual. 

I  have  purposely  italicized  "at  times"  for  the  rea- 

192 


Deductions 

son  that  my  investigations  show  that,  the  force  is  only 
propagated  during  the  time  one  side  of  the  brain  is 
temporarily  incapacitated  (unless  color  is  employed, 
page  192).  It  is  necessary  to  show  in  further  experi- 
ments if  it  is  possible  for  an  individual  to  inhibit  vol- 
untarily one  side  of  the  brain. 

If  in  my  experiments  I  have  utilized  the  stomach- 
-  muscle  as  an  index  in  revealing  force  and  its  trans- 
mission, conventionalism  has  not  been  disregarded. 

Frogs'  legs  are  now  employed  for  recording  wire- 
less messages  (Fig.  34).  Psycliists  have  accepted  the 
contracting  muscles  of  the  frog  as  the  first  definite 
index  of  thought-transference.  Our  nerves  and  mus- 
cles are  more  complex  and  responsive  than  those  of  a 
frog. 

"Cheiro,"  in  his  "Language  of  the  Hand," 
describes  an  instrument  for  measuring  psychic 
force  and  maintains  that,  the  indicator-needle  of 
his  instrument  establishes  the  reality  of  thought. 
Careful  investigation  by  two  members  of  the 
"Society  for  Psychical  Research"  demonstrated 
that  the  results  were  due  to  other  causes. 

The  "sthenometer"  of  Dr.  Paul  Joire,  is  sup- 
posed to  fulfill  the  same  indications  as  the  former. 

A  more  thorough  understanding  of  psychic 
force  may  explain  the  phenomena  of  telekinesis. 

It  is  reasonable  to  suppose,  considering  the  data 
already  presented  that  the  force  of  the  organism 
may  be  compared  to  the  magnetic  force. 

Magnets  act  at  a  distance  although  there  is  no 
apparent  medium  connecting  them  with  the  object 
acted  upon. 

The  most  tenable  theory  supposes  that,  the  flux 
of  the  magnet  passes  out  at  its  north  pole  and  re- 
enters  it  at  its  south  pole. 

In  other  words,  the  magnet  at  one  pole  is  like  a 
force-pump  and  at  the  other  pole,  it  is  like  a 
suction-pump.  After  this  manner  attraction  and 
repulsion  are  explainable. 

193 


Progressive     Spondylotherapy 

COLOR. — The  experiments  on  page  130,  direct  atten- 
tion to  the  influence  of  color  on  tonicity  of  the  organs. 
The  therapeutic  value  of  colors  (chromotherapy)  has 
been  acknowledged  on  empirical  lines. 

Percussion  demonstrates  that  in  the  light,  the  or- 
gans show  more  tonicity  and  better  delimitation 
(page  184)  than  in  the  dark.  Respecting  the  action 
of  color  on  the  tonicity  of  the  stomach,  vide  page  129, 

Fleming,  in  his  book  "Waves  and  Ripples"  shows 
that  there  are  many  more  ether-waves  than  are  cur- 
rently supposed  in  the  solar  spectrum  and  with  the 
diffraction  spectrum  of  Langley,  it  has  been  shown 
that  the  greatest  heating  power  is  not  found  in  the  . 
infra-red,  but  in  the  orange  or  orange-yellow.  We 
found  that  these  colors  will  augment  the  action  of 
the  forces  (pages  129  and  191). 

In  the  spectrum  one  finds  radiations  varying  in 
length  from  several  miles  long  (oscillations  of  Hertz) 
to  less  than  .000009  of  an  inch  (violet  rays).  Light  is 
an  electromagnet  disturbance  of  the  ether.  It  is  in 
this  way  only  that  one  can  account  for  the  penetrat- 
ing effects  of  light  as  shown  in  my  experiments.  I  am 
assuming  that,  light  is  positively  or  negatively  charg- 
ed and  colors  are  probably  only  different  charges 
(page  203.) 

Dullness  produced  by  yellow  (page  128)  is  at  once 
dissipated  by  violet,  blue  or  green.* 

Why  red  permits  the  transmission  of  psychic  force 
with  the  brain  acting  in  its  entirety,  I  cannot  say  oth- 
er than  to  suppose  that  it  is  oppositely  charged  to  the 
two  hemispheres  of  the  brain. 

*In  my  works  on  "Autointoxication,"  (page  245),  and  "Diagnostic- 
Therapeutics,"  color  in  diagnosis  (chromodiagnosis),  has  been  discussed. 

194 


Deduction 


POPULAR   QUESTIONS 

PERSONAL  MAGNETISM. — Although  this  phrase  is 
now  employed  figuratively,  at  one  time  it  had  a  liter- 
al significance.  It  was  supposed  that  ia  physical 
force  equivalent  to  that  exhibited  by  a  magnet  passed 
from  one  person  to  another.  This  conception  of  per- 
sonality was  Abandoned  when  science  was  unable  to 
demonstrate  a  so-called  transmitted  vital  force.  If 
one  reviews  the  history  of  medicine  one  finds  that,  the 
great  men  in  the  profession  owed  their  success  to 
their  personality.  ''Successful  treatment,"  said  Hu- 
f eland,  "requires  one-third  science  and  two-thirds 
savoir-faire."  Science  and  heart  are  so  nicely  blend- 
ed in  the  truly  great  physician  that  neither  is  opera- 
tive separately.  "Cheer  is  a  powerful  drug,  for  a 
merry  heart  doeth  good  like  a  medicine. ' ' 

The  so-called  personal  magnetism  has  been  chiefly 
exhibited  by  "healers"  who  were  not  physicians. 
Their  presence  or  manipulations  seemed  to  arouse 
the  latent  energy  of  the  patient  and  endow  him  with 
increased  vitality. 

With  the  facts  presented  are  we  in  a  position  to 
deny  teledynamics  or  a  transmission  of  energy  ? 

What  is  known  as  induction  of  magnetism  is  the 
communication  of  the  latter  to  a  piece  of  iron  with- 
out actual  contact  with  a  magnet  and  by  this  process 
the  piece  of  iron  will  have  two  poles ;  the  pole  nearest 
to  the  pole  of  the  inducing  magnet  being  of  the  oppo- 
site kind,  while  the  pole  at  the  farther  end  is  of  the 
same  kind  as  the  inducing  pole. 

This  inductive  action  is  like  that  observed  when  a 
nonelectrified  body  is  brought  under  the  influence  of 
an  electrified  one.  (Vide,  page  139.) 

Can  we  deny  that  the  animal-force  of  one  individu  - 
al  cannot  act  on  another  by  induction  ? 

195 


Progressive     Spondylotherapy 

Magnets  have  their  likes  and  dislikes  as  exhibited 
by  attraction  and  repulsion.  All  matter  has  the  same 
attractive  force.  Every  molecule  is  a  magnet  and  is 
electrified.  Some  are  powerful  and  others  feeble. 

As  a  rule,  a  natural  lode  stone  cannot  lift  its  own 
weight  yet  Sir  Isaac  Newton,  had  a  lodestone  set 
in  his  hand  ring  which  although  weighing  but  three 
grains  could  lift  233  times  its  own  weight. 

Chemical  affinity  is  probably  only  the  magnetic 
properties  of  molecules. 

My  friend,  Carl  Snyder,  in  his  remarkable  book, 
"New  Conceptions  in  Science,"  observes:  What  we 
used  to  call  loves  and  hates  of  the  chemical  "affini- 
ties" was  but  a  name  for  the  action  of  electrically 
charged  atoms.  Thus  chemistry  like  light  will  be  an- 
nexed to  the  wide  domain  of  electricity. 

Lord  Kelvin,  refers  to  matter  as  minute  whirls  of 
" vortex-rings."  These  rings  are  like  the  smoke-rings 
from  a  locomotive  or  from  tobacco.  Two  smoke-rings 
attract  each  other  like  little  worlds  and  if  stopped  by 
an  obstacle  in  a  room,  they  will  move  on  again  when 
the  obstacle  is  removed.  Gravitation  is  a  relatively 
weak  force  when  compared  with  the  enormous  mole- 
cular forces.  In  accounting  for  personal  magnetism 
due  regard  must  be  paid  to  the  vibration-rate  during 
transmission  of  the  force  and  to  the  fact  whether  the 
recipient  is  properly  attuned  to  these  vibrations. 
Personal  likes  or  dislikes  may  only  be  questions  of 
individuals  in  or  out  of  tune  (page  206). 

Music  AND  NOISE. — Every  phenomenon  in  nature 
depends  on  matter  in  motion  or  vibration.  In  music 
we  are  dealing  with  vibrations  which  create  pleasant 
mental  images  and  emotions.  The  physical  reaction 
of  the  organism  to  music  is  manifested  by  changes  in 
the  pulse-rate  and  blood-pressure.  Quiet  and  restful 

196 


Deductions 

numbers  reduce  the  latter.    Horace,  in  his  Thirty- 
second  Ode,  Book  1.,  concludes  his  address  to  the  lyre : 

"O  laborum,  dulce  lenimen,  mihicumque  salve. 

Bite  vocanti." 

(O,  of  our  troubles  the  sweet,  the  healing  sedative). 

A  line  of  poetry  is  nought  else  but  simple  physical 
processes ;  it  means  the  rate  of  heart-beat  and  regu- 
larity or  irregularity  of  breathing  of  the  author  at 
the  time  the  verse  was  written. 

Bacon,  Milton  and  others,  recognized  the  value  of 
music  as  a  stimulant  to  intellectual  work.  By  aid  of 
the  ergograph  it  can  be  shown  that,  when  the  fingers 
are  fatigued,  music  will  restore  their  vigor.  Sad  mu- 
sic will  have  a  contrary  effect.  Experiments  on  dogs 
demonstrated  that  music  increases  the  elimination  of 
carbonic  acid,  increases  the  consumption  of  oxygen 
and  augments  the  functional  activity  of  the  skin.  In 
consequence  of  its  acknowledged  physiologic  action, 
music  has  been  employed  (musicotherapy)  in  the 
treatment  of  mental  and  nervous  affections.  In  the 
classics,  we  recall  that  the  singing  of  birds  was  the 
method  employed  to  cure  the  insomnia  of  Maecenas. 

The  author  is  inclined  to  regard  the  pathology  of 
many  nervous  affections  as  the  physics  of  abnormal 
vibrations. 

Recalling  the  observations  on  page  156,  respecting 
visceral  attraction  and  repulsion,  it  has  been  found 
that  music  and  the  vibrations  of  a  tuning-fork  will 
increase  the  descent  of  the  liver  whereas  noises  will 
not  only  destroy  this  attraction  but  may  cause  an  act- 
ual repulsion  of  the  organ. 

Many  popular  expressions  like,  "  shattered 
nerves,"  " nerves  in  tension,"  and  " upset  nerves," 
are  employed  to  describe  the  sensations  of  nerves  in 
disorder.  The  foregoing  expressions  may  be  literally 
true  if  we  regard  the  structures  of  the  body  as  infini- 

197 


Progressive     Spondylotherapy 

testimal  magnets  with  modified  polarity  (Vide,  page 
182),  or  bear  in  mind  the  molecular  vibration  of 
nerve-tissue  and  the  response  of  such  tissue  to  the 
vibrations  of  tuning-forks  as  shown  on  page  206. 
Molecular  vibration  is  a  universal  law. 

COSMIC  INFLUENCES. — It  is  generally  conceded  that 
the  cosmic  forces  exhibit  a  potent  influence  upon  the 
organism.  The  nature  of  this  influence  is  but  little 
understood.  The  pains  of  rheumatic  and  gouty  sub- 
jects are  modified  by  conditions  of  the  weather. 

Edward  Dexter17,  has  contributed  an  important 
monograph  bearing  on  the  mental  and  physiological 
effects  of  metereological  conditions. 

In  a  living  organism  a  part  of  the  available 
energy  is  necessary  for  the  vital  processes  of  living, 
while  the  reserve  energy  goes  into  the  intellectual 
processes. 

Weather-conditions  play  on  the  reserve  energy 
by  affecting  oxidation,  which  is  the  chemical  basis 
of  life.  Inhabitants  of  hot  climates  are  apathetic 
and  improvident.  An  equable,  moist  temperature 
weakens  body  and  mind.  The  most  favorable  tem- 
perature for  health,  with  its  aggressive  energy,  is 
about  55  degrees  F.  and  this  is  found  in  the 
temperate  zones.  The  dominant  peoples  are  shown 
between  the  25th  and  55th  parallels. 

The  effect  of  weather  has  been  shown  upon 
human  conduct  by  marked  fluctuation  of  immoral 
acts.  We  find  ourselves  out  of  sorts  on  hot, 
humid,  cloudy,  and  perhaps  rainy  days.  We  have 
always  known  the  influence  that  weather-changes 
play  in  the  causation  of  disease,  especially  in  the 
so  -  called  barometric  neuroses.  The  total  atmos- 
pheric pressure  at  sea  level  on  an  adult  body 
is  about  fifteen  tons.  Variations  of  this  pres- 
sure are  compensated  by  resiliency  of  the  blood- 
vessels, which  equalizes  the  circulatory  disturb- 
ances. In  the  old,  however,  the  diminished  arterial 
elasticity  accounts  for  the  headache,  rheu- 
matic pains,  drowsiness,  etc.,  resulting  from 
altered  pressure.  Relative  rarity  of  the  air  with 
oxygen  deficiency  induces  exhaustion.  Electric 
storms  produce  headache.  Positive  atmospheric 

198 


Deductions 

electricity  stimulates  and  the  negative  variety 
present  in  inclement  weather  depresses  the  indi- 
vidual. 

Arrhenius,  has  striven  to  show  that  various  physio- 
logical processes,  notably  menstruation,  are  related  to 
electrical  variations  of  the  atmosphere  and  the  chem- 
ical changes  thereby  effected.  At  the  suggestion  of 
this  celebrated  savant,  experiments  are  now  being 
conducted  upon  50  school  children  in  Stockholm,  to 
determine  the  effect  of  electricity  upon  the  growth  of 
children. 

The  application  of  electric  currents  to  the  soil  has 
been  shown  to  increase  the  quantity  and  quality  of 
its  products. 

The  influence  of  terrestrial  magnetism  (page  140) 
on  the  physiologic  processes  must  be  an  important 
one. 

The  phenomena  of  terrestrial  magnetism  as  exhib~ 
ited  in  magnetic  storms  and  the  auroral  light  seems  to 
have  their  analogies  in  the  "brain-storms'  and  phot- 
isms. 

CLOTHING. — Light-hunger,  and  may  we  add  light 
over-feeding,  are  potent  factors  in  disease.  A  poverty 
of  light  is  no  less  pernicious  in  its  effects  than  the  ex- 
cessive light  of  the  tropics.  Tropical  neurasthenia 
has  been  attributed  to  overstimulation  by  the  actinic 
rays  of  tropical  sunshine.  In  our  experiments  we 
have  noted  that,  relaxation  of  the  organs  (diminish- 
ed tonicity)  ensues  when  the  solar  rays  are  focused 
on  individual  organs.  At  a  distance  the  rays  augment 
the  tonicity  of  the  organs  (page  128).  We  have  found 
that  the  rays  contracting  the  stomach  act  through 
black  clothing  and  that  the  action  of  these  peculiar 
penetrating  rays  may  be  inhibited  by  violet,  green  or 
blue.  It  is  therefore  suggested  that  for  light-hunger, 

199 


Progressive     Spondylotherapy 

yellow  (page  130)  garments  should  be  used  and  the 
other  colors  when  the  light  is  too  intense. 

We  have  found  that  each  time  the  light  from  an  in- 
candescent bulb  is  allowed  to  act  on  the  head,  the 
stomach  of  the  subject  shows  dullness.  The  latter  en- 
sues with  all  colors  excepting  yellow.  It  is  therefore 
suggested  that  this  color  should  be  utilized  as  a  lining 
for  hats  when  it  is  desired  to  minimize  brain-activity 
due  to  the  influence  of  light. 

Magnetic  rings,  belts,  etc. — Magnetism  is  frequent- 
ly exploited  by  the  unscrupulous  advertiser  who  sells 
to  the  unwary  rings,  belts,  pads  and  garments  sup- 
posedly endowed  with  magnetic  virtues.  These  have 
been  repeatedly  tested  by  the  author  with  results 
which  were  invariably  negative. 

What  is  obvious  cannot  compete  with  what  is  ob- 
scure in  the  treatment  of  disease,  hence  the  success  of 
the  charlatan. 

If  magnetism  is  desired,  the  expenditure  of  a  few 
cents  would  purchase  a  really  efficient  magnet. 

DEXTRAL  OR  SINISTRAL  SYMPTOMS. — For  some  rea- 
son, patients  will  complain  of  symptoms  predominat- 
ing either  on  the  right  or  left  side  of  the  body.  Such 
complaints  I  have  heretofore  regarded  as  ridiculous. 
The  cortical  sensory  areas  dominate  opposite  halves 
of  the  body.  If  the  skin  on  the  right  side  of  the  body 
is  irritated,  stomach-dullness  ensues  but  the  latter 
cannot  be  elicited  if  the  skin  of  the  left  half  of  the 
body  is  irritated.  The  tonicity  of  the  right  lobe  of  the 
liver  is  increased  by  irritating  the  skin  on  the  left 
side  and  a  like  action  is  exhibited  by  the  left  lobe  of 
the  liver  when  the  skin  on  the  right  side  is  irritated. 
A  few  inhalations  of  some  anesthetic  prevent  the 
foregoing  effects. 

200 


S          u          m          m          a 

SUMMARY* 

1.  The  trend  of  scientific  opinion  is  to  reduce  all 
force  to  a  single  underlying  principle  and  to  unify  as 
it  were,  the  various  forms  of  force  (115). 

The  theory  of  the  Conservation  of  Energy,  showing 
the  transmutation  of  force  (116)  corroborates  the 
foregoing. 

The  Aristotelian  conception  of  "Soul"  as  "the 
vital  principle"  or  the  generally  accepted  distinction 
of  Descartes,  between  mind  and  matter  (res  cogitans 
and  the  res  extensa)  is  no  more  acceptable  than  the 
belief  of  theologians  that,  there  existed  in  man  an  im- 
ponderable, incorruptible  and  incombustible  bone 
which  was  necessary  for  the  nucleus  of  the  resurrec- 
tion body. 

One  may  speculate  with  metaphysics,  but  science 
invariably  investigates  and  progresses  along  the  lines 
of  sense-impressions. 

Science  never  transcends  human  intelligence,  nor 
does  it  invoke  in  the  interests  of  its  doctrines  any 
suspension  of  nature's  laws;  for  after  all,  "Facts  are 
the  words  of  God. ' ' 

The  religionist  denies  that  science  offers  consola- 
tion to  the  soul.  Applied  to  the  ignorant,  this  conten- 
tion may  be  true  but  the  educated  cannot  reconcile 
doctrines  in  conflict  with  progressive  science.  The 
doctrine  of  "Immortality"  is  by  no  means  alluring. 
Annihilation  of  self  is,  according  to  the  religion  of 
Buddha,  perfect  rest,  and  is  not  to  be  feared  when  old 
age  has  come  with  its  inevitable  assemblage  of  infirm- 
ities. Haeckel,  relates  the  legend  of  the  unhappy  Ah- 
asuerus,  who  vainly  sought  death  after  finding  his 
eternal  life  intolerable.  The  orthodox  doctrine  of  the 

*The  number  or  numbers  in  parentheses  refer  to  the  page  or  pages  in 
this  work  respecting  the  subject-matter  from  which  conclusions  have 
been  formulated. 


Progressive     Spondylotherapy 

soul  supported  by  spiritualistic  philosophers  is  that, 
it  possesses  none  of  the  properties  of  matter ;  that  it 
is  created  simultaneously  with  the  body,  and  that  it  is 
capable  of  itself,  independent  of  any  other  cause,  of 
controlling  the  bodily  functions. 

We  must  regard  life  as  a  force  active  on  and 
through  matter. 

2.  The  electronic  theory  (115)  employed  in  expla- 
nation of  physiotherapeutic  action,  supposes  the  re- 
sults to  be  effected  by  the  interplay  of  moving  parti- 
cles electrically    charged.    The    action   in    question 
causes  the  discharge  of  reflexes. 

3.  Stimulation  predicates  a  discharge  of  animal- 
force  (164),  and  one  of  the  evidences  of  the  latter,  is 
augmented  tonicity  of  the  organs  and  tissues  (123). 

4.  The  chief  source  of  animal-force  is  probably 
derived  from  the  heart  (164)  and  its  distribution  in 
the  organism  is  one  of  the  functions  of  the  autonomic 
nervous  system   (25).     The  sympathetic  system  is 
probably  only  negatively  active. 

5.  Animal-force,  as  far  as  its  physiological  action 
is  concerned,  cannot  be  differentiated  from  the  other 
forms  of  force.  It  is  a  form  of  energy  like  light,  heat, 
electricity,  magnetism  and  the  X-rays. 

Electricity  is  an  invariable  property  of  matter  but 
matter  and  electricity  are  so  intimately  associated 
that  they  are  practically  the  same.  The  organism  may 
be  regarded  as  an  aggregation  of  electrified  corpus- 
cles and  in  this  sense,  all  life-processes  (vitality)  and 
electricity  are  identical.  What  we  regard  as  animal 
force  or  energy  may  be  the  electrical  charge  of  the  in- 
dividual atoms  whereby  one  set  is  positively  charged 
and  the  other  negatively.  Here,  force  must  be  regard- 
ed as  a  vehicle  of  energy :  in  motion,  it  is  current  and 
magnetism,  under  strain,  charge  and  in  vibration, 
light.  Animal-light,  peculiar  to  luminous  fish,  crus- 

202 


Summary 

taceans  and  zoophytes  may  thus  be  explained.  Phot- 
isms  (glossary)  are  likewise  explainable. 

6.  Assuming  the  electronic  theory  to  be  correct 
(115),  the  atoms  of  matter  constituting  the  organism 
are  negatively  and  positively  charged  and  that,  if  an 
electron  is  withdrawn  from  the  atom  the  latter  is  left 
positively  electrified. 

The  organs  exhibiting  attraction  and  repulsion 
(156)  conform  to  the  law  that,  bodies  charged  with 
one  kind  of  electricity  repel  those  charged  with  the 
same  kind,  but  attract  those  charged  with  the  oppo- 
site kind. 

7.  The  organs  are  maintained  in  their  normal  po- 
sition by  an  electromagnetic  attractive  force.   If  the 
latter  is  partially  removed  (186),  the  organs  fall,  and 
rise  when  supplied  with  any  of  the  various  forms  of 
force,  the  most  potential  of  all  being  the  magnetic 
force. 

Color  likewise  influences  the  relative  position  of  the 
organs  as  will  be  subsequently  noted. 

8.  My  experiments  with  light  and  colors  (127  and 
194)  seem  to  prove  that,  the  so-called  spectral-colors 
consist  objectively  of  very  rapid  transverse  electro- 
magnetic vibrations  of  the  ether,  ranging  from  ap- 
proximately 400  millions  of  millions  per  second  for 
red  to  760  millions  of  millions  for  violet.    This  theory 
assumes  that  waves  of  light  are  not  mere  mechanical 
motions  of  the  ether,  but  that  they  are  undulations 
partly  magnetic  and  partly  electrical.     In  addition 
to  this  theory,  I  assume  that  colors  represent  differ- 
ent electrical  charges. 

The  visible  spectrum  of  " white  light"  is  only  about 
one-tenth  of  the  actual  measurable  solar  spectrum. 
The  sense  of  color  is  probably  variations  in  the 
amount  of  energy.  Thus,  the  energy  necessary  to  pro- 
duce the  sensation  of  red  must  be  100,000  times  as 

203 


Progressive     Spo  ndy  1  o  th  er  apy 

great  as  the  energy  necessary  to  produce  the  im- 
pression of  green. 

Two  spectral-colors  producing  by  their  mixture  the 
sensation  of  white  are  known  as  complementary  col- 
ors. They  are  as  follows : 

Red  and  green-blue ; 

Golden  yellow  and  blue ; 

Blue,  green  and  violet. 

It  has  been  shown  (153)  that  the  positive  or  north 
pole  or  the  south  or  negative  pole  of  a  magnet  will, 
by  increasing  the  tone  of  the  stomach  transform  a 
tympanitic  into  a  dull  sound  (reaction)  but  if  the  two 
poles  are  employed  synchronously,  the  poles  are  neu- 
tralized and  no  dullness  ensues.  Like  poles  yield  a 
reaction  ivhen  presented  in  the  same  direction. 

When  colors  were  used  with  the  poles  of  a  magnet, 
the  following  was  observed : 

a.  Yellow  with  the  negative  pole,  no  reaction ; 
Yellow  with  the  positive  pole,  a  reaction; 

b.  Green  with  negative  pole,  a  reaction; 
Green  with  positive  pole,  no  reaction ; 

c.  Violet  with  negative  pole,  a  reaction ; 
Violet  with  positive  pole,  no  reaction ; 

d.  Blue  with  negative  pole,  a  reaction ; 
Blue  with  positive  pole,  no  reaction ; 

e.  Red  gives  a  positive  reaction  with  both  poles. 
From  the  foregoing,  one  is  constrained  to  conclude : 

Yellow  is  positively  charged,  whereas  green,  violet 
and  blue  are  negatively  charged  and  red,  is  both  posi- 
tively and  negatively  charged. 

We  know  that  an  intense  white  light  (from  an  in- 
candescent lamp)  will  produce  stomach-dullness  when 
directed  on  the  gastric  region  (128). 

All  of  the  complementary  colors  yield  a  positive 
reaction. 

When  the  positive  pole  of  a  magnet  is  directed  to- 

204 


Summary 

ward  the  stomach,  it  yields  a  positive  reaction,  but, 
if  the  subject  swallows  2  grains  of  medicinal  methy- 
lene  blue,  there  is  no  reaction. 

This  latter  experiment  may  aid  us  in  elucidating 
the  disputed  photo-chemical  theories  of  color-per- 
ception and  may  show  that  the  retinal  excitation  of 
colors  is  dependent  on  positively  or  negatively  charg- 
ed electromagnetic  vibrations. 

The  gastrologist  may  utilize  this  method  for  deter- 
mining many  obscure  problems.  Thus,  if  a  blue 
colored  substance  is  ingested  with  the  food,  the  dura- 
tion of  digestion  (or  the  time  when  the  food  leaves 
the  stomach)  may  be  determined  by  the  reappearance 
of  stomach-dullness  when  the  stomach  is  exposed  to 
the  flux  of  the  positive  pole  of  a  magnet. 

My  investigations  suggest  that,  the  position  of  the 
organs  is  influenced  by  color,  and  it  is  not  improbable 
that,  the  red  color  of  arterial  blood  and  the  blue  color 
of  venous  blood  were  destined  in  part  for  the  specific 
object  of  hastening  the  circulation. 

The  light  of  a  red  incandescent  lamp  over  the  heart 
and  a  blue  lamp  over  the  region  of  the  liver  causes 
the  latter  to  ascend.  By  reversing  the  position  of  the 
lamps,  the  opposite  condition  ensues— the  liver 
descends. 

8.  The  X-rays  are  not  different  from  ordinary 
light  when  the  physiological  test  suggested  (148)  is 
established  as  a  criterion  of  action.  Indeed,  there  are 
media  impervious  to  the  X-rays  which  permit  of  the 
penetration  of  light. 

9.  The  transmission  of  energy  from  one  organism 
to  another  has  been  established  (164). 

The  energy  developed  in  contracting  a  muscle  dem- 
onstrates the  same  physiologic  action  as  the  energy 
generated  by  thought.  The  content  of  thought  like 
color  is  probably  dependent  on  the  number  of  waves 

205 


Progressive     Spondylo therapy 

in  a  second  of  time  or  by  the  corresponding  wave- 
length. Thus,  we  may  speak  of  the  physics  of 
thought. 

It  is  within  the  range  of  probability  that  some 
means  may  be  discovered  for  modifying  the  vibra- 
tions of  the  psychic  force  and  thus  establish  the  con- 
tent of  thought. 

10.  The  recognition  of  animal-force  and  the  util- 
ization of  like  forces  suggests  many  possibilities  in 
the  realms  of  science,  notably  in  the  direction  eluci- 
dating many  obscure  problems  in  pathology.  We 
may  eventually  define  pathology  as  the  physics  of 
abnormal  vibrations.  By  aid  of  appropriate  vibra- 
tions we  may  restore  the  equipoise  of  the  body  by  a 
rearrangement  of  the  molecules  or  by  raising  their 
vibration  to  a  normal  standard  of  frequency.  This 
action  corresponds  to  tone-vibrations  which  set  other 
bodies  in  motion.  Thus,  if  the  A-string  of  a  violin  is 
struck,  the  A-string  of  a  piano  standing  near  sounds 
in  harmony  with  it.  It  is  not  improbable  that  inves- 
tigations along  lines  here  suggested  will  demonstrate 
that  each  organism  has  its  normal  standard  of  vibra- 
tion and  this  will  be  modified  by  disease.  In  my  lim- 
ited observations,  it  was  found  that,  the  transition  of 
the  tympanitic  sound  to  the  stomach-dullness  in  the 
norm  was  effected  with  tuning-forks  with  a  vibration- 
number  of  256.  When  the  vibrations  were  very  much 
above  or  below  this  standard  the  results  were  nega- 
tive. By  increasing  the  tone  of  the  vagus  (page  123), 
the  stomach  responds  to  higher  or  lower  vibrations. 
In  making  the  tests  the  tuning-fork  is  held  in  proxim- 
ity to  the  stomach. 

Faith  cures  may  be  attributed  to  the  creation  of 
energy  or  the  rearrangement  of  tissue-molecules  by 
powerful  emotions.  Thus,  we  may  speak  of  the 
physico-chemistry  of  cures. 

206 


Summary 

11.  The  dominant  action  attributed  to  the  reflexes 
(5  and  40)  in  our  mechanistic  conception  of  the  life- 
processes,  is  in  accordance  with  our  belief,  that  in- 
stinct is  a  mere  expression  of  the  various  forms  of 
force.    The  phenomena  of  the  animal-body  are  vital 
demonstrations  of  chemistry  and  mechanics,  and  are 
as  irresistible  as  the  force  which  causes  the  magnet  to 
attract  iron  filings.     The  bee  constructs  a  perfect 
cell  without  a  mathematical  education  and  birds  mi- 
grate without  chart  or  compass. 

12.  In  accepting  the  reaction  of  the  stomach-mus- 
culature as  a  basis  for  our  varied  deductions,  we  are 
employing  bioplasmic  matter  (126),  the  most  prim- 
itive and  sensitive  substance  for  exhibiting  the  phe- 
nomenon of  vitality.    The  reaction  manifested  by  in- 
creased tonicity  is  absolute,  definite  and  easy  of  inter- 
pretation by  a  recognized  method  of  examination 
known  as  percussion. 

Other  organs  (notably,  the  heart)  exhibit  increased 
tonicity  but  the  stomach  is  preferred  for  the  reaction 
insomuch  as  any  change  in  its  sound  is  easier  of  in- 
terpretation. 

Contractions  of  the  stomach  may  be  easily  demon- 
strated by  aid  of  a  manometer  (Fig.  21)  or  a  record- 
ing apparatus  (Fig.  42). 

By  aid  of  the  gastrodiaphane,  one  may  note  a  dim- 
inution in  the  area  of  the  stomach-illumination  by 
approaching  the  region  of  the  stomach  with  an  ordin- 
ary horseshoe  magnet.  Transillumination  in  this  way 
however,  is  too  gross  for  recognizing  the  transmission 
of  energy. 

Any  electrical  difference  of  potential  (that  is,  dif- 
ference in  amount  of  positive  or  negative  electricity) 
is  indicated  by  the  swing  of  the  needle  of  the  Galvan- 
ometer. 

To  further  prove  the  correctness  of  my  observa- 

207 


Progressive     Spondylotherapy 

tions,  a  stomach-tube  converted  into  a  non-polaris- 
able  electrode  was  introduced  into  the  stomach  and 
the  hand  of  the  subject  immersed  in  a  salt-solution. 
Tube  and  vessel  were  connected  with  a  very  sensitive 
Galvanometer. 

When  a  yellow  light  or  a  horseshoe  magnet  ap- 
proached the  stomach-region,  the  readings  were  in- 
variably negative  to  the  original  electrical  potential. 

Green  light  yielded  no  results  but  psychic  energy 
through  a  red  medium  covering  the  head  of  another 
subject  (page  192),  gave  the  same  effects  as  the  mag- 
net and  yellow  light.  The  magnet  caused  the  great- 
est deflection  of  the  needle. 


208 


GLOSSARY 

BIOPLASM. — Any  living  matter.  Also  known  as 
protoplasm,  sarcode,  biogen  and  cytoplasm.  It  always 
contains  the  following  12  essential  elements ;  calcium, 
carbon,  chlorin,  hydrogen,  iron,  magnesium,  nitrogen, 
oxygen,  phosphorus,  potassium,  sodium  and  sulphur. 

CREMASTERIC  REFLEX. — Drawing  up  of  the  scrotum 
and  testicle  when  the  skin  on  the  inner  side  of  the 
thigh  is  irritated. 

ELECTROLYSIS. — Decomposition  of  a  salt,  a  chemi- 
cal compound  or  certain  tissues  of  the  body  by  aid  of 
electricity.  The  substances  so  decomposed  are  known 
as  electrolytes. 

ELECTROTAXIS. — The  reaction  of  protoplasm  (ani- 
mal or  vegetable)  to  one  or  the  other  electric  pole. 
Positive  electrotaxis  refers  to  the  living  body  attract- 
ed toward  the  cathode  (negative  pole)  or  repelled 
from  the  anode  (positive  pole).  The  reverse  process 
is  called  negative  electrotaxis. 

ERGOGRAPH. — An  instrument  used  for  recording 
the  value  of  work  done  by  muscular-contractions. 

The  ergodynamograph  records  muscular-force  in 
addition  to  the  value  of  the  work  effected  by  muscu- 
lar-contractions. 

ETHER. — A  highly  tenuous  medium  filling  all  space 
as  well  as  solids  and  liquids  and  supposed  to  be  the 
vehicle  for  transmission  of  the  various  forms  of 
force. 

GASTRODIAPHANE. — A  small  electric-light  bulb  in- 
troduced into  the  stomach.  Examinations  show  trans- 
illumination  of  the  anterior  wall  of  the  organ. 

HELIOTROPISM. — Also  known  as  heliotaxis  and  a 
form  of  phototaxis.  Growth  or  movement  toward 
(positive  h.)  or  away  from  (negative  h.)  the  sun  or 
the  sunlight. 

209 


Progressive     SpondylothSrapy 

IONS. — Groups  of  atoms  conveying  charges  of  elec- 
tricity. Ions  charged  with  negative  electricity  (from 
the  positive  pole  or  anode),  are  known  as  anions  and 
those  charged  with  positive  electricity  (at  the  nega- 
tive pole  or  cathode),  are  called  cations. 

LODESTOXE. — Iron  ore  attracting  other  pieces  of 
iron.  Specimens  of  lodestone  are  natural  magnets. 

METABOLISM. — A  term  employed  to  signify  tissue- 
change  and  embraces  the  sum  of  the  chemical  changes 
subserving  the  functions  of  nutrition.  It  includes  con- 
structive (anabolism)  and  destructive  (catabolism) 
changes. 

PEECUSSION. — An  important  method  of  diagnosis 
first  employed  by  Auenbrugger,  a  Viennese  physician 
in  1761,  and  appearing  in  his  work,  Inventum  Novum. 

The  basis  of  percussion  consists  of  differentiating 
resonant  from  dull  sounds.  By  its  aid  one  can  deter- 
mine the  density  and  tone  of  organs  and  define  the 
situation  of  the  latter.  Resonant  notes  are  produced 
over  organs  containing  air  whereas  airless  organs 
yield  dull-notes. 

PHOTISMS. — Subjective  phenomena  of  luminosity. 
Individuals  feel  as  though  a  dark-room  became  sud- 
denly illuminated.  Photisms  have  been  coincident 
with  many  conversions.  Saint  Paul  had  a  blinding 
heavenly  vision. 

The  observation  that  rays  similar  to  the  N-rays  are 
given  out  from  the  body  and  detected  by  a  fluorescent 
screen  has  never  been  confirmed  and  the  same  refers 
to  the  colored  rays  of  Hooker. 

POLARIZED  LIGHT. — A  change  effected  in  a  ray  of 
light  passing  through  certain  medium  (e.  g.,  tourma- 
line) called  a  polariser.  The  transverse  vibrations 
occur  in  only  one  plane  in  lieu  of  in  all  planes  as  in 
the  ordinary  ray  of  light. 

210 


Glossary 

PROTEID. — Also  known  as  protein.  A  group  of  sub- 
stances making  up  the  greater  part  of  animal  and 
vegetable  tissues  and  formed  chiefly  by  plants. 

PSYCHISTS. — Believers  in  psychic  force  or  tliose 
engaged  in  psychical  research.  The  term  psychic  is 
also  used  to  designate  an  individual  who  is  endowed 
with  the  power  of  communicating  with  spirits  (spir- 
itualistic medium).  Psychism  as  a  doctrine  refers  to 
a  universal  soul  animating  all  living  beings,  the 
difference  in  their  actions  being  due  to  the  difference 
of  individual  organizations. 

REFLEXOMETER. — An  instrument  for  measuring  the 
force  necessary  to  excite  a  reflex. 

SPLANCHNOPTOSIS. — Also  known  as  Glenard's  dis- 
ease and  visceroptosis.  Refers  to  an  abnormal  sink- 
ing down  of  the  abdominal  organs. 

SUGGESTION. — Implanting  an  idea  in  the  mind  of 
another  person  by  some  act  or  word  on  the  part  of  the 
operator.  This  is  tantamount  to  the  artificial  produc- 
tion of  a  certain  psychic  condition.  Experimenters 
are  frequently  influenced  by  the  same  condition  (au- 
to-suggestion) and,  in  their  state  of  expectant  atten- 
tion, they  frequently  perceive  what  they  expect  to 
perceive. 

TELEKINESIS.- — An  alleged  spiritisic  manifestation 
whereby  movements  of  objects  are  effected  without 
contact  with  the  mover. 

TYMPANITIC. — Refers  to  the  sound  elicited  by  per- 
cussion over  organs  containing  air  (stomach  and  in- 
testines). The  pitch  of  a  percussion  note  over  the 
stomach  depends  chiefly  upon  the  tension  of  its  walls 
enclosing  the  air.  When  the  tension  of  the  walls  is  in- 
creased, a  tympanitic  is  converted  into  a  non-tympan- 
itic  or  dull  sound  and  the  latter  is  again  converted 
into  a  tympanitic  note,  when  the  walls  of  the  stomach 
are  relaxed. 

211 


BIBLIOGRAPHY 

1.  Taylor. — Monthly  Cyclopedia  and  Med.  Bull., 
Feb.,  1911. 

2.  Willard.— The  Journal  of  Osteopathy,  March, 
1912. 

3.  Folin  and  Denis. — Jour.  Biolog.    Chem.  Jan. 
XIII,  No.  4. 

4.  Franke.— Berl.  Klin.  W.,  Oct.  14,  1912.    Brit. 
Med.  J.,  Nov.  30, 1912. 

5.  Chiari. — Verh.  d.  deutsch,  path.  Gesell.,  1903, 
p.  137. 

6.  Marchand.— Hid.,  p.  197. 

7.  Goldscheider.— Wien.  Med.  Klin.,  No.  12,  1912. 

8.  Gwathmey. — J.  Am.  Med.  Ass.,  Dec.  17,  1901 
and  N.  Y.  Med.  Jour.,  Sept.  14, 1912. 

9.  Einhorn. — Medical  Record,  Jan.  15, 1910. 

10.  Ewart— Brit.  Med.  Jour.,  Dec.  28, 1912. 

11.  Moore.— J.  A.  M.  A.,  Aug.  10, 1912. 

12.  Peterson.— N.  Y.  Med.  Rec.,  Dec.  31,  1892. 

13.  King.— Medical  Century,  Sept.,  1910. 

14.  Sellheim.— Jour.  A.  M.  A.,  May  10,  1906. 

15.  Bragg.— Nature,  Dec.  12, 1912. 

16.  Abrams.— Medical  Record.  March  26, 1898. 

17.  Dexter. — Weather  Influences,  1904. 


212 


INDEX 


Abdominal   supporters,   101. 

Accessorius,  10. 

Action  currents,  165. 

Adrenalin,   8,    32,   34,   43. 

Algesimeter,   12. 

Amblyopia,   34,    108. 

Ampere's  theory,   181. 

Amytl  nitrite,  66. 

Anesthesia,  scopolamin,  44. 

Anesthetics,  82. 

Aneurysms,  50,  55,  et  seq. 

Aneurysms,  skiagrams  of,  13,  14. 

Angina  pectoris,  52. 

Animal   electricity,    176. 

Animal  force,  176,  202,  206. 

Animal  tissues,    143. 

Aorta,   abdominal,    58. 

Aorta,   dilated,  44,   57. 

Aortitis,  56. 

Aortoptosis,   57. 

Appendicitis,  94,  97. 

Appendix,  tenderness  of,  28. 

Asthenopia,    108. 

Asthma,  12,  42,  43,  48,  56;  62;  94 

Asthma,  cardiac,  57. 

Atomic  theory,   173. 

Atoms,    116. 

Atonic  constipation,   11,  48. 

Atophan,  20. 

Autointoxication,  93 

Automaton,  33. 

Autonomic  system,  25. 

Backache,  17. 

Bibliography,   212. 

Bioplasm,    126. 

Bismuth   meal,  93,  95. 

Bladder  reflex,'  108. 

Blood,  after  spleen  reflexes  108. 

Blood,   coagulation   of.  46,  62. 

Blood,  in  hyperthyroidism,  78. 

Blood,  pressure  of,  53. 

Bolometer,    118. 

Bose,  investigations  of,   179. 

Cachexia  strumipriva,  71. 
Calcimeter,  46. 

Calcium,  action  on  stomach,  130. 
Calcium,  therapy,  45  et  seq. 
Capillary   dynamometer,   69. 
Capillaries,   flushing   of,   70. 
Cardiospasm,  80. 


Cecum,  95. 

Centrotherapy,  36. 

Cervical  sympathetic,  76,  77. 

Cirrhosis   of  liver,  97. 

Clothing,  199. 

Cocain,  82. 

Coccygeal  ganglion,  70. 

Coccygodynia,  22. 

Colloids,   122. 

Color,  194,  203. 

Color,  effect  on  reflexes,  128. 

Color,  on  tonicity  of  organs,  130. 

Color,  and  stomach  dullness,  205. 

Color,  and  psychic  force,  191. 

Colon,    carcinoma   of,   94. 

Colon,  intubation  of,  90,  93. 

Colonic   stasis,  93. 

Complementary  colors,  204. 

Concusspr,   59. 

Concussion,    spinal,    123. 

Consciousness,   174. 

Constipation,  10,  95. 

Contractures,  67. 

Cosmic  influences,  198. 

Coughs,  104. 

Crymotherapy,  37. 

Demagnetization,  139,  160,  161,  187. 

Depressor  nerve,  55. 

De    Puysegur,    134. 

Diagnosis,  6. 

Diamagnetism,  139. 

Diaphragm  reflex,   14. 

Diaschisis,  24. 

Digestive  apparatus,  80. 

Dolores  vagi,  93. 

Drugs,  184. 

Duodenal-intubation,  85. 

Duodenal  ulcer,  84,  94. 

Dysbasia  angiosclerotica,  65. 

Dyschromatopsia,   34. 

Dysthyroidism,  72. 

Edema,  108. 
Electricity,  119,  202. 
Electricity,  animal,   176. 
Electricity,  and  magnetism,   145. 
Electricity,  and  suggestion,  117. 
Electrons,   116. 
Electronic  theory,  115,  202. 
Electronotherapy,  115,  119,  127. 


215 


Progressive     Spondylotherapy 


Electro-optical  phenomena,  158. 

Emotion,  30,  32,  159,  191. 

Endocarditis,  52. 

Energy,  115,  164,  178,  201,  205. 

Enterotoxism,   83. 

Epilepsy,  65. 

Esophagus,  80. 

Esophagus,  percussion  of,  88. 

Exercises,  47. 

Exophthalmic  goitre,  10,  36,  71, 

et  seq. 
Eye,  20. 

Faith  cures,  206. 

Fluoroscope,  57. 

Force,  animal,  176,  202. 

Force  of  heart,  187. 

Force,  and  matter,  115. 

Force,  physics  of,  113. 

Force,  psychic,  188. 

Force,  transmission  of,  164,  et  seq, 

Force,   vital,   178. 

Freezing,  39. 

Frog,  106,  149,  193. 

Gall-bladder,  98. 
Gangrene,  family,  66. 
Gastric  juice,  16. 
Gastrodiaphane,  207. 
Gauge,  spondymobile,   110. 
Gilbert   132. 
Glaucoma,  109. 
Glossary,  209. 
Goitre,    intrathoracic,    57. 
Gubler's  method,  20. 
Gynecology,    reflexes   in,    100. 

Heberden's  nodes,  21. 

Headaches,  46,  66. 

Heart,  force  of,  187. 

Heart,  inspection  of,  50. 

Heart,  reflex,  51. 

Heart,  tests   for,  50. 

Heart,  vago-visceral  palpation  of, 

14,   50. 
Heat,  129. 
Heliotropism,   122. 
Hippocrates,    4. 
Hirschsprung's   disease,  91. 
Hydrochloric    acid,    84. 
Hyperemia  test,  66. 
Hyperpiesis,  54. 
Hypertension,    54. 
Hyperthyroidism,  72. 
Hypotheses.  173. 
Hysteria,  184. 

Hys-teria,  diagnosis  of,  29  et  seq. 
Hysteria,  pains  of,   18. 


Ideas,  29. 
Ideopath,  29. 
Immortality,  201. 
Inhibition,  reflex,  41. 
Instinct,  5. 

Intermittent  limp,  65. 
Intubation,    colonic,   90. 
Intubation,  duodenal,  85. 
Intuitional  acts,  15. 
lodoform,  72. 
lodothyrin,  72. 
Ions,   122. 

Kidneys,    187. 
Klemperer's  test,  83. 

Lavage,  transduodenal,  83. 
Life.   178,  et  seq. 
Light,  127,  202. 
Liver,   cirrhosis   of,  97. 
Locomotor  ataxia,  104. 
Lodestone,   196. 
Lumbago,   19. 

Magnesium— perhydrol,  84. 

Magnetic  force,  and  animal  tissues, 
143. 

Magnetic    force,   historical,    131,    135. 

Magnetic    force,    mechanical    effects, 
of,    140. 

Magnetic  force,  and  percussion,  150. 

Magnetic   force,  physics  of,  138,  et  seq. 

Magnetic  force,  physiological  physics 
of,  142,  et  seq. 

Magnetic  force,  and  stomach-border. 
171. 

Magnetic    force,    and    stomach-tone, 
145. 

Magnetic   force,  theory  of,   139,   181. 

Magnetic  force,  and  visceral  tone,  145. 

Magnetic  force,  and  voluntary  mus- 
cles, 155. 

Magnetism,   personal,   195. 

Magnetism,  theory  of.   181. 

Magnetic  ring=,  etc.,  200. 

Magnets,  in  diagnosis,  136. 

Mammary  tumors,   102. 

McBurney's  point,  28. 

Medulla  oblongata,  104. 

Mesmer,    133. 

Metal,  phenomena  of,  179. 

Microbiology,  179. 

Monroe's  point,  29. 

Morris's   point,  29. 

Muscles,  rigidity  of,  13. 

Music,   196. 

Myocardial   insufficiency,    10,   50. 


216 


n 


Nerves,  blocking  of,   106. 
Nerves,    stimulation    of,    122. 
N.crvi  erigentes,  64. 
Neurasthenia,   18. 
Neuritis,   12. 

Neuroses,   barometric,    198. 
Neuroses,  .traumatic,    185. 
Noise,  196. 

Odic   force,   134. 
Orificial  methods,  70. 
Osteoarthritis,   21. 
Osteopathy,  2. 
Ovary,  prolapse  of,  101. 

Pain,  17,  38,  46. 
Pain,  peripheral,  105. 
Pain,  points  of  tenderness,  28. 
Pain,  visceral,  25,  26. 
Pancreas,  98. 

Pancreas,  tenderness  of,  28. 
Pancreatic  secretion,  9,   16. 
Paracelsus,  132. 
Paralysis,  periodic,  66. 
"Parathyroids,  71. 
Percussion,  topographic,  184. 
Perkins,    134. 
Perspiration,    64. 
Pertussis,    103. 
Physiatrics,   117. 
Physiotherape-utics,    117. 
Pilocarpin,   34,   51. 
Pithiatism,  29. 
Pituitrin,   51. 
Plethysmograph,  68. 
Posture,    faulty,  22. 
Precordium,    50. 
Protoplasm,   119. 
Psychic  force,  188,  et  seq. 
Psychrotherapy,  37,  et  seq. 
Pupil,  42,  77. 
Pylorospasm,   82. 
Pylorus,  16.  82,  88. 
Pyramidal  tract,  41. 

Radium,  116,  125. 

Raynaud's  disease,  67. 

Rectum,  95. 

Reflexes,  174. 

Reflex  actions  and  life,  5. 

Reflex,  explanation  of,  121. 

Reflex,  miscellaneous,   100,   121. 

Reflex,   prolongation   of,   182. 

Reflex,  reinforcement  of  40,  44,  183. 


Reflex,  scrotal,  8. 
Reflex,  skin,  149. 
Reflex,  stomach,  146. 
Reflexodiagnosis,  5. 
Reflexology,  1. 
Reflexophilic.   5. 
Reflexotherapy,  36,  127. 
Rheumatism,  19. 
Robson's  point,  28. 
Rubber-bandage,  66. 

Sacralgia,   22. 

Sacrp-i-liac  percussion,  96. 

Salpingitis,  29. 

Selenium,    174. 

Senses,  unreliability  of,  118. 

Sensibility,   forms  of,   12. 

Scopolamin   anesthesia,  44. 

Sideroscope,    136. 

Sigmoid-flexure,  89. 

Solar  rays,  128. 

Sorgo  treatment,  128. 

Spinal  cord,  vessels  of,  65. 

Spinal  cord,  concussion  of,  123. 

Spinthariscope,   116. 

Splanchnic  nerves,  9. 

Splanchnic   neurasthenia,    13. 

Splanchnoptosis,  185,  et  sea. 

Splanchnoptosis,  pelvic,  101. 

Spleen,  functions  of,  106. 

Spondylectrode,  96. 

Spondylopressor,  9,  34,   51,   74. 

Spondylotherapy,   1. 

Spondymobile  gauge,  110. 

Sthenometer,  193. 

Stomach,   81. 

Stomach,  action  of  salt  on,  130. 

Stomach,  dorsal  resonance  of,  84. 

Stomach,  percussion,    123,    145,    152; 

153,    163. 

Stomach,   records  of  contractions,  167. 
Stomach,   reflex,   146,   147. 
Stomach,  ulcer ,  128. 
Stretcher,  21. 
Suggestion,  31,  36,  117. 
Supporters,  abdominal,  101. 
Sympathetic,  cervical,  76. 
Sympathetic,  demagnetization    of,  162. 
Symptoms,    200. 

Tabes,  66. 

Tachycardia,  52,  75. 
Telekinesis,  193. 
Temperature;  168. 
Terrestrial  magnetism,  140. 


217 


Progressive    Sp on dylo therapy 


Tetany,  71. 
Thought,  190. 
Thyroid  extract,  77. 
Thyroid  gland,  71. 
Thymus  gland,  71. 
Thyrotoxicosis,    71. 
Tone,  8,  ISO,  162. 
Tonicity,  175. 
Tonometry,  visceral,  6. 
Tractors,  134. 
Tuberculosis,  104. 
Tympanites,  gas-trie,  84. 
Tympanitic,  sound,  124,  147. 

Uric  acid,  20. 
Uterine  myomata,  73. 
Uterus,   prolapse   of,   101. 

Vagus,  10,  74,  75,  153,  161. 
Vagus,   enervation   of,   10. 
Vagus,  visceral  methods  of,  14. 


Vasoconstriction,  67. 
Vasodilation,  67. 
Vasomotor  mechanism,  62. 
Vasomotor  neuroses,  62. 
Vertebrae,  reaction  to  pain,  17. 
Vertebrae,  'tenderness  of,  17. 
Verumontanum,    108. 
Vibration,  206. 
Visceral,    attraction    and    repulsion, 

156,  184,  203. 

Visceral,  demagnetization,  160. 
Visceral,  disease  and  backache,  17. 
Visceral,  muscle,  7. 
Visceral,  pain,  25,  27. 
Visceral   reflexes,  7. 
Visceral,  tone,  8,  150. 
Visceral,  tonometry,  6,   10. 
Vital- force,  178. 
Vomiting,  of  pregnancy,  84. 

X-rays,  125,  129,  158,  205. 


PROGRESSIVE 
SPONDYLOTHERAPY 

1914 


CONTENTS 


Spondylotherapy 

Spondylotherapy  in  General  Practice 

Vertebral  Tenderness  and  Visceral  Disease 

The  Circulatory  System    - 

Angina  Pectoris 

Cardiac  Insufficiency 

Heart  Reflex     - 

Blood-Pressure 

The  Digestive  System  - 

The  Pylorus 

Gall-Bladder     - 

Splanchnic  Neurasthenia  - 

Miscellaneous  Data 

Poliomyelitis 

Trigemmal  Neuralgia  - 

Cerebrasthenia        - 

Radicular  Roentgenotherapy  - 

Urticaria  and  Migraine     - 

Pigmentation  of  the  Skin 

Movable  Kidney    -  - 

Malaria    -           -           -          -          - 

Pelvic  Level  - 

Prolapsus  Uteri  ... 

Painless  Labor          .... 


PERISCOPE  OF 

PROGRESSIVE  SPONDYLOTHERAPY* 

1914 


SPONDYLOTHERAPY. 

J.  Madison  Taylor,  A.  B.,  M.  D.,  of  Philadelphia,  in  the 
Monthly  Cyclopedia  and  Medical  Bulletin  (July,  1913),  in 
a  contribution,  "An  Appreciation  of  the  Teachings  of 
Dr.  Abrams,"  refers  to  the  detached  and  fragmentary  atten- 
tion accorded  to  the  "spinal  reflexes"  by  the  medical 
profession. 

He  continues: 

"Dr.  Abrams  has  focused  our  attention  on  one,  in 
my  opinion,  likely  to  yield  increasingly  valuable  re- 
turns— that  of  the  scope  and  significance  of  the  spinal 
reflexes.  In  his  book  will  be  found  an  impressive  aggre- 
gation of  convincing  evidence  gleaned  from  the  whole 
realm  of  scientific  medical  findings.  He  has  digested 
this,  analyzing  and  bringing  together  detached  facts, 
displaying  their  significance,  their  practical  interrela- 
tionships, and  subjoining  his  own  pronouncedly  original 
interpretations  and  recommendations. 

To  this  achievement  he  has  added  the  products  of  a 
ripe  experience  and  knowledge  gathered  from  the  best 
sources,  not  only  of  his  own  but  the  personal  and  hospital 
service  of  domestic  and  foreign  leaders  in  opinion.  He 

*Numbers  in  parentheses  (not  italicized)  refer  to  the  pages  in  "SPONDYLOTHERAPY" 
where  the  subject  has  already  been  discussed.  When  the  numbers  in  paren- 
theses are  italicized,  they  refer  to  the  pages  in  "PROGRESSIVE  SPONDYLO- 
THERAPY," 1913. 


Progressive     Spondylotherapy 

has  presented  his  postulates,  inferences,  and  conclusions 
to  the  candid  criticism  of  those  whom  we  have  learned  to 
regard  as  competent  judges  of  survival  values. 

Although  he  has  made  a  deep  impression  upon  the 
consciousness  of  many  a  reputable  physician,  the  very 
brilliance  of  his  findings,  the  simplicity  of  his  remedial 
principles,  the  unusual  promptitude  of  his  results  in 
many  heretofore-called  incurable  states,  induce  sus- 
picion and  doubt  in  the  minds  of  those  who  refuse  to 
examine  the  evidence  or  give  him  a  fair  hearing.  How- 
ever, the  ground  for  my  welcoming  this  new  angle  of 
vision,  this  novel  explanation  of  long-obscured  phenom- 
ena, did  not  grow  overnight,  but  is  the  logical  result  of 
much  browsing  along  unfamiliar  paths,  noting  appear- 
ances, and  studying  illuminating  principles  of  physiology 
and  therapeutics.  It  seems  to  me,  there  is  now  soon  to 
be  reduced  to  an  exact  science  the  genus  and  differentia 
of  a  domain  of  clinical  medicine  which  will  warrant  the 
judicious  consideration  of  all  whose  aspiration  it  is  to 
relieve  the  sufferings  of  mankind. 

The  significance  of  reflex  irritation  as  an  etiological 
factor  in  physiological  disorders  is  obviously  a  large  one, 
demanding  the  most  thorough  investigation.  There 
exists  here  a  vast  array  of  findings  awaiting  expert  study. 
When  we  come  to  the  domain  of  psychopathies  the  re- 
search has  only  begun.  At  the  present  time,  medical 
literature  is  full  of  contributions  from  psychopatholo- 
gists  and  those  who  enjoy  the  conviction  that  they  come 
within  this  class.  These  are  not  only  those  who  really 
know  something  about  psychopathic  and  neurotic  phe- 
nomena, but  a  larger  group  convinced  of  the  adequacy  of 
psychopathological  findings  to  explain  and  cure  any 
malady.  Freud  and  his  disciples  offer  much  ground  for 
curing  through  psychoanalysis,  accepting  as  their  ques- 
tionable credo  the  sexual  impulse  and  its  endless  divaga- 
tions. Sidis  shows  plainly  that  the  fear  instinct  domi- 
nates all  other  causal  agencies.  So  of  other  lines  of  evi- 
dence. Back  of  all  lies  the  domain  of  physical  deter- 


Progressive     Spondylotherapy 

minants  of  [psychopathic  [phenomena.  And  the 
major  portion  of  these  are  sources  of  reflex  irritation — 
causal  agencies  working  through  spinal  nerves. 

Among  the  more  recent  and  promising  propositions 
is  the  postulate  of  Upson,  of  Cleveland,  that  dental  irri- 
tation, especially  non-sensory  forms  of  irritation — im- 
pactions,  deformations,  latent  abscesses,  and  the  like — 
offer  ground  for  the  elucidation  of  physical  deteriora- 
tions, psychopathies,  insomnias,  and  even  insanities. 
My  experience  leads  me  to  feel  great  confidence  in  this 
view. 

In  brief,  we  have  no  right  to  abandon  hope,  in  a  host 
of  baffling  conditions,  until  all  avenues  of  possible  reflex 
irritation  are  searched.  Until  we  have  greatly  amplified 
our  knowledge  in  many  directions,  we  cannot  search 
confidently  or  hopefully. 

The  light  which  Dr.  Abrams'  researches  afford  is  the 
largest  source  of  illumination — and  I,  for  one,  welcome 
it  with  thankfulness." 

S.  Edgar  Bond,  B.  L.,  M.  D.  of  Richmond,  Indiana,  in 
The  American  Journal  of  Clinical  Medicine  (Aug.  1913), 
in  an  article,  "Spondylotherapy;  a  New  Therapeutic 
Method,"  deplores  the  inability  of  the  world  to  appreciate 
an  innovation  which  disturbs  preconceived  notions.  The 
medical  profession  is  particularly  bitter  against  anything 
new  and  the  individual  who  proposes  any  advance  to  cure  an 
incurable  disease  (so-called)  becomes  the  object  of  such 
abuse  that  he  is  indeed  a  lion-hearted  man  who  ventures  to 
face  such  opposition.  In  consequence  of  this  attitude  many 
brilliant  discoveries  are  lost  to  the  profession.  "The  fact 
that  men  and  women  foremost  in  the  ranks  of  scientific 
medicine  are  investigating  and  using  Spondylotherapy  in 
hospitals  and  daily  practice  with  such  remarkable  success  in 
the  cure  of  so-called  incurable  diseases  has  aroused  the  inter- 
est of  the  medical  profession  as  few  things  have  done  in  the 
last  few  years." 

3 


Progressive     Spondylotherapy 

Thanks  to  Dr.  Albert  Abrams,  who  originated  the  term 
"Spondylotherapy, "his  scientific  findings  have  rescued  spinal 
work  from  vague  uncertainties  and  unscientific  pretensions 
which  have  marked  the  reign  of  the  charlatan  and  narrow 
misguided  spine  and  bone  manipulator. 

"We  realize  that  some  self-constituted  'censors'  of  medi- 
cine who,  without  study  of  the  breadth  of  Spondylotherapy  and 
investigation  of  the  spirit  of  its  founder,  are  fearful  there  is  a 
new  "cult"  appearing  upon  the  alreadv  overcrowded  medical 
horizon." 

Spondylotherapy  is  the  most  scientific  adjunct  to  the 
practice  of  medicine  and  will  turn  back  clinical  medicine  into 
its  own. 

No  one  using  Spondylotherapy  employs  it  exclusively. 

The  spine  has  heretofore  been  regarded  from  an  ana- 
tomic and  physiologic  viewpoint,  but  we  must  now  look  at  it 
from  the  clinical  standpoint — representing  as  it  does,  centers 
from  which  reflexes  may  be  evoked  to  be  utilized  in  the  treat- 
ment of  disease. 

Almost  positive  proof  of  our  diagnosis  may  be  obtained 
from  the  fact  that  vertebral  tenderness  (71)  at  definite  spinal 
segments  is  indicative  of  certain  visceral  affections. 

Thus:  tenderness  over  the  4th  lumbar  spine  of  the  female 
suggests  uterine  disease;  at  the  3rd,  ovarian;  on  the  right 
side  of  the  2nd  lumbar,  appendix;  at  the  loth,  nth  and  i2th 
dorsal,  the  kidneys,  etc. 

"A  well-known,  albeit  recent  student  of  reflexotherapy 
enthusiastic  with  his  results  was  bewailing  his  failure  to 
trust  its  keeness  of  diagnosis  and  related  an  experience. 
'I  was  called  to  see  a  patient  who  was  suffering  keenly  from 
an  acute  pain  in  the  region  of  the  appendix.  My  only  thought 
was  an  immediate  operation  until  examination  of  the  spine 
failed  to  reveal  any  tenderness  over  the  segment  related  to 

4 


Spondyloth     e    r    a    p    y 

the  appendix  (2nd  lumbar)  although  extreme  tenderness 
was  present  over  the  segments  related  to  the  kidneys. 

On  the  third  day,  chemical  examination  of  the  urine  by 
another  physician  demonstrated  nephritis  and  by  aid  of 
spinal  methods  the  patient  quickly  recovered. 

Complications  following  the  proposed  operation  would 
I  am  sure,  have  proven  fatal." 

"Recently,  a  friend  of  mine,  after  he  had  seen  the  eyes 
of  an  exophthalmic  patient  recede  and  protrude  under  the 
excitation  of  the  reflexes  (74)  and  had  the  same  comfirmed 
by  a  third  physician,  said,  'I  saw  it  but  don't  believe  it.' 

"Spondylotherapy  cannot  supplant  scientific  medicine 
but  is  its  handmaid  and  the  greatest  foe  to  the  careless  use 
of  the  unreliable  galenicals  and  shotgun  prescriptions,  and  of 
the  patent-medicine  vender,  just  as  broad  scientific  medicine 
is  always  a  foe  to  quackery  in  all  its  forms." 

Sir  James  Barr,  M.  D.,  L.  L.  D.,  F.  R.  S.  E.,  in  his 
President's  address  at  the  i8th  annual  meeting  of  the 
British  Medical  Association,  referred  to  reflexology  as 
follows: 

"The  versatile  genius  of  Dr.  Albert  Abrams,  who  has 
come  all  the  way  from  San  Francisco,  to  do  honor  to  this 
meeting  of  the  British  Medical  Association,  has  taught 
us  how  best  to  cure  intrathoracic  aneurysm  and  he  has 
shed  light  on  the  nature  of  the  cardiac  and  respiratory 
reflexes.  In  the  treatment  of  diseases  of  the  heart  and 
lungs  his  work  does  great  credit  to  the  new  Continent 
and  he  has  also  given  us  further  insight  into  methods  of 
prevention." 

In  his  thesis  (Contribution  a  V6tude  de  la  REFLEXO- 
THERAPIE  (636, 1}  presented  to  the  "University  of  Toulouse," 
Jean  Vaquier,  comments  on  the  remarkable  therapeutic  re- 
sults achieved  by  reflexotherapeutic  methods. 

5 


Progressive     Spondylotherapy 

In  attempting  to  explain  these  results,  he  quotes  Brown- 
Sequard  who  said  with  reason,  that  it  is  impossible  to  irritate 
any  sensory  region  of  the  organism  without  causing  some 
disturbance  of  nearly  the  entire  nervous  system. 

The  same  observer  remarked  that  it  often  only  sufficed 
to  seize  a  cat  by  the  skin  in  the  cervical  region  to  evoke  an 
epileptic  paroxysm. 

Physiology  is  nought  else  but  a  summation  of  reflexes. 

In  pathology  we  are  likewise  dealing  with  a  series  of 
reflexes;  the  presence  of  intestinal  parasites  will  produce 
meningeal  symptoms;  cold  acting  on  the  feet  may  conduce 
to  tympanites  and  colic  and  cutaneous  burns  may  lead  to 
ulceration  of  the  intestinal  mucosa. 

The  President,  Dr.  Remond,  and  the  Dean,  Dr.  Jeannel, 
in  commenting  on  the  thesis  of  Vaquier  observed  that  it  was 
quite  impossible  to  attribute  the  results  achieved  by  reflex- 
otherapy  to  suggestion  or  the  impressionable  state  of  the 
subject.  Assuming  for  argument,  however,  that  suggestion 
is  the  basis  of  the  therapeutic  methods,  then  the  latter  should 
be  employed  nevertheless  for  the  chief  object  of  the  physician 
is  to  relieve  or  cure  his  patients. 

SPONDYLOTHERAPY  IN  GENERAL  PRACTICE. 

The  following  abstract  is  from  a  contribution  by  Charles 
L.  Ireland  (Columbus,  Ohio),  which  was  read  at  the  recent 
convention  (Sept.  30,  1913)  of  "The  American  Association 
for  the  Study  of  Spondylotherapy" 

Chronic  SUBINVOLUTION,  chronic  ENDOMETRITIS,  VER- 
SIONS, FLEXIONS,  PROLAPSED  UTERI,  PROLAPSED  OVARIES  and 

RELAXED  VAGINAE  are  as  a  rule  easily  corrected  and  cured 
by  the  intelligent  use  of  Spondylotherapy  (100). 

The  same  applies  to  atonic  and  spastic  CONSTIPATION 

(327). 

6 


Spondylotherapy    in    General    Practice 

In  the  examination  of  a  patient  one  must  primarily 
search  for  vertebral  tenderness  and  the  localization  of  the 
latter  is  dependent  on  the  organ  involved  (71). 

By  aid  of  Spondylotherapy  relief  and  cure  are  now  more 
easily  attained  than  heretofore. 

A  case  of  METRORRHAGIA  may  be  cited:  A  woman  has 
been  flowing  and  dribbling  for  six  months.  All  methods  of 
treatment  have  proved  futile.  If  the  uterus  is  not  ectopic 
or  there  is  no  fibroid,  excitation  of  the  UTERUS  REFLEX  (358, 
1 06)  will  after  several  treatments  bring  about  complete 
relief. 

If  in  confinement  there  is  HEMORRHAGE  caused  by  a  re- 
tained placenta,  excitation  of  the  uterus  reflex  by  pressure 
or  concussion  of  the  first  three  lumbar  spines  will  arrest  the 
bleeding.  This  method  to  control  hemorrhage  and  expel  the 
placenta  is  more  efficient  than  Crede's  method  or  the  use  of 
ergot. 

In  AMENORRHEA  (notably  in  young  girls),  sinusoidaliza- 
tion  for  the  treatment  of  SPLANCHNIC  NEURASTHENIA  (434) 
is  most  efficient. 

The  later  condition  is  frequently  responsible  for  malposi- 
tion of  the  uterus  owing  to  the  added  weight  of  the  accumu- 
lated blood  in  the  splanchnic  area. 

PROLAPSED  OVARIES  (without  adhesions)  may  be  re- 
stored to  their  normal  position  by  concussion  or  sinusoidal- 
ization  of  the  loth,  nth  and  i2th  dorsal  vertebrae.  This 
latter  appears  chimerical  but  is  nevertheless  true. 

In  the  differentiation  of  APPENDICITIS  and  OVARITIS, 
definite  localization  of  the  areas  of  vertebral  tenderness  (75) 
is  invaluable. 

In  the  treatment  of  RECTOCELE,  sinusoidalization  at  the 
4th  lumbar  spine,  in  CYSTOCELE  at  the  ist  lumbar  spine  and 
at  the  latter  spinous  process  in  ENURESIS,  is  very  effective. 


Progressive     Spondylotherapy 

In  HEPATIC  CONGESTION,  by  evoking  the  liver  reflex  of 
contraction  (331)  and  contracting  the  gall-bladder  'V6oo), 
relief  is  secured  in  a  few  minutes  whereas  the  use  of  calomel 
is  only  effective  after  24  hours.  The  latter  observation  sug- 
gests the  query,  Why  use  calomel^ 

The  pains  of  a  DUODENAL  ULCER  are  relieved  in  a  few 
minutes  by  concussion  of  the  loth  dorsal  spine  to  augment 
the  flow  of  pancreatic  juice  (pp)  and  thus  alkalinize  the  chyme 
which  has  escaped  into  the  duodenum. 

In  GALL-STONE  COLIC,  concussion  of  the  gth  dorsal  spine 
(599),  by  securing  a  larger  opening  for  gall-stones  is  often 
effective. 

In  two  patients  with  CARDIOSPASM  (80,  589)  who  suffered 
from  regurgitation  of  food,  prompt  relief  was  secured  by 
sinusoidalization  between  the  3rd  and  4th  dorsal  spines. 

Opening  the  PYLORUS  (82)  by  mere  pressure  with  the 
thumb  on  the  right  side  of  the  5th  dorsal  spine  will  give 
almost  immediate  relief  in  gastric  indigestion. 

This  method  is  also  available  in  the  use  of  nauseating 
drugs  (82). 

Instead  of  employing  the  nauseating  stomach-tube  for 
lavage,  the  patient  is  instructed  to  ingest  two  quarts  of 
water  (containing  some  antiseptic  if  necessary),  and  then  by 
pressure  at  the  5th  dorsal  spine,  the  contents  of  the  stomach 
are  evacuated  into  the  duodenum. 

In  the  diagnosis  of  DUODENAL  ULCER  one  may  at  once 
precipitate  an  attack  of  pain  by  pressure  at  the  5th  dorsal 
spine  for  reasons  already  cited  (84). 

Many  cases  of  duodenal  ulcer  have  been  cured  by  other 
physicians  and  myself  by  sinusoidalization  or  concussion  of 
the  loth  dorsal  spine  (99)  with  the  object  of  increasing  the 
flow  of  pancreatic  juice,  thus  subjecting  the  ulcer  to  a  con- 
tinuous bath  of  alkaline  secretion. 

8 


Spondylotherapy    in    General    Practice 

Many  paroxysms  of  HAY-FEVER  may  be  jugulated  by 
concussion  of  the  yth  cervical  spine  and  repetition  of  this 
maneuver  on  subsequent  days  is  often  curative. 

Symptomatic  cure  has  been  achieved  in  two  cases  of 
PROSTATIC  HYPERTROPHY  by  suiusoidalization  of  the  i2th 
dorsal  spine  (634)  supplemented  by  chromium  sulphate(635). 

In  early  PHTHISIS  excellent  results  may  be  achieved  by 
increasing  the  vascularity  of  the  lungs  (602). 

"When  a  nursing  mother  finds  her  milk  deficient  in 
quantity  and  fears  that  she  will  have  to  wean  her  baby,  in 
lieu  of  augmenting  the  diet  to  produce  more  milk,  concuss  or 
sinusoidalize  the  3rd  and  4th  dorsal  spines.  Three  or  four 
treatments  usually  suffice  to  stimulate  the  mammary  glands 
to  normal  activity." 

This  treatment  for  AGALORRHEA  has  been  employed  suc- 
cessfully in  a  number  of  patients. 

"There  is  one  class  of  patients  that  I  am  anxious  to  en- 
counter, and  that  is  cases  of  apparent  ELECTROCUTION 
from  contact  with  high  tension  electric  wires.  In 
the  case  of  every  electrocution,  death  has  been  produced 
by  profound  shock  of  the  vasoconstrictor  nerves  sup- 
plying the  heart  and  blood-vessels.  An  electric  current 
sufficiently  strong  to  produce  death  will  contract  the 
arteries  to  such  an  extent  that  the  heart  is  unable  to 
pump  any  blood  through  them.  Here  I  would  apply  a 
powerful  sinusoidal  current  or  concussion  to  the  vaso- 
dilator centers,  viz.,  3rd,  4th,  loth,  nth  and  i2th  dor- 
sals; alternating  this  treatment  with  concussion  or  sinu- 
soidalization  of  the  4th  cervical  and  8th  dorsal  spines  to 
contract  the  diaphragm,  and  force  air  from  the  lungs  to 
assist  in  breathing.  Then  I  would  use  the  interrupted 
sinusoidal  current  at  intervals  of  one  minute  at  the  vaso- 
dilator centers.  Should  the  heart  not  respond,  I  would 
alternate  with  the  sinusoidal  current  or  concussion  at  the 
centers  corresponding  to  the  vasoconstrictor  and  vaso- 
dilator nerves  of  thejieart. 

9 


Progressive     Spondylotherapy 

In  conclusion,  I  want  to  add  one  more  thing  to 
Spondylotherapy  which  I  believe  will  alleviate  much 
suffering.  This  refers  not  only  to  painful  menstruation 
but  also  to  child-birth,  viz.,  DILATATION  OF  THE  CERVIX. 
After  experimenting  with  about  fifty  cases,  I  find  that 
by  concussion  or  rapid  sinusoidal  current  applied  to  the 
loth  dorsal  vertebra,  you  will  get  a  rapid  dilatation  of 
the  cervix.  By  this  aid  you  may  assist  nature  to  accom- 
plish this  dilatation  more  rapidly  than  by  depending 
upon  the  labor  pains  alone  and  hasten  the  time  of  con- 
finement by  reducing  the  pain  to  a  minimum.  Some  of 
you  may  think  that  by  rapid  dilatation  the  patient  is  in 
danger  of  hemorrhage,  but  by  having  the  vasocon- 
strictor nerves  under  your  control  you  can  easily  obviate 
any  seriousness  of  that  nature.  Before  this  treatment 
is  tried  the  operator  must  have  a  full  knowledge  of  the 
vasoconstrictor  and  vasodilator  centers." 

Dr.  B.  E.  Dawson  (Kansas  City,  Mo.),  contributes  the 
following  concise  report: 

"Cullen  said,  'There  are  more  false  facts  than  theo- 
ries in  the  world.'  It  certainly  is  true,  that  many  state- 
ments labelled,  'Facts,'  are  soon  relegated  to  oblivion. 
Many  laboratory  facts  are  false  in  the  sick-room;  many 
facts  in  the  test-tube  are  false  in  the  human  system;  the 
enthusiast  with  one  idea  often  presents  'facts'?  that  are 
absolutely  false. 

We  are  living  in  an  age  of  doubt,  demanding  demon- 
stration. Facts  must  be  confirmed  by  the  rigid  test  of 
experience.  A  great  fact  may  be  so  obscured  with  so- 
called  facts,  as  to  retard  its  progress  or  mar  its  utility. 
While  all  truth  is  eternal,  and  all  truth  is  Divine,  it  may 
be  prostrated  and  lie  supine,  held  there  by  error,  until 
rescued  by  those  searching  for  it.  No  man  makes 
truth,  he  reveals  it.  After  it  is  revealed,  it  must  often 
fight  for  recognition.  Innovations  are  usually  unwel- 
come and  meet  with  strong  opposition. 

Dr.  Abrams  has  more  recently  discovered  and  re- 
vealed to  the  world  another  great  and  marvelous  truth — 

10 


Spondylotherapy    in     General    Practice 

that  of  making  a  switch  board  of  the  spinal  column, 
whereby  we  can  send  a  message  to  any  viscus.  We  thus 
get  the  reflex  of  contraction  or  dilatation;  we  reach  the 
sympathetic  via  the  cerebro-spinal.  This  truth  is  fight- 
ing over  the  same  battle-ground  as  did  its  predecessors 
for  recognition.  The  orificialist  can  readily  grasp  the 
truth  of  Spondylotherapy,  because  he  has  made  a  close 
study  of  the  law  of  reflexes.  He  is  ready  to  receive  it 
and  test  it  out;  he  has  been  waiting  for  Spondylotherapy 
as  an  aid  to  his  own  work.  Speaking  somewhat  loosely, 
or,  in  a  limited  way,  using  the  license  of  liberty,  granted 
in  figures  of  speech,  'Orificial  Surgery'  sends  a  massage 
to  the  mother  of  the  body  household  economy,  and  she 
then  commands  the  children.  Spondylotherapy  speaks 
to  the  children,  commanding  or  encouraging  them  to  do 
their  proper  work.  What  a  boon  to  the  mother,  when  a 
child  is  in  the  dumps,  or  fired  with  anger  is  working  too 
fast,  or  doing  the  wrong  work,  to  have  a  kind  friend 
assist  in  setting  things  right.  What  a  great  help  when 
Orificial  Surgery  has  sent  the  message  to  the  mother, 
and  she  is  doing  her  best  to  get  the  children  in 
line,  to  have  |this  Jbig  brother  step  in  among  these 
children  and  render  his  assistance. 

I  attended  Dr.  Abrams'  class  last  November,  and  was 
delighted  with  his  instruction  and  charmed  with  his 
demonstrations.  He  told  us  that  concussion  of  the  spine 
of  the  fifth  dorsal  vertebra  would  empty  the  stomach  into 
the  duodenum  (5  88,  82).  On  the  morning  of  the  last  day 
of  his  class,  I  got  up  with  a  violent  sick  headache,  a  very 
unusual  thing  with  me.  I  braced  up  and  went  to  the 
class  room,  where  in  a  short  time  I  felt  impelled  to  leave 
the  room  for  emesis.  I  informed  Dr.  Abrams  of  my 
condition,  when  he  requested  me  to  come  forward,  take 
a  seat  before  the  class  and  remove  my  coat.  He  then 
concussed  the  spine  of  the  fifth  dorsal,  for  a  few  seconds, 
when  to  my  surprise  and  relief,  my  nausea  was  all  gone. 
This  confirmation  was  intensely  personal,  and  the  evi- 
dence of  the  witness  was  indubitable. 

11 


Progressive     Spondylotherapy 

The  next  morning,  on  the  train,  on  my  way  to  Kan- 
sas City,  the  negro  porter  rushed  into  the  wash  room  of 
the  sleeper,  asking:  'Is  dar  a  doctah  in  heah?  Bar's  a 
mighty  sick  lady  in  de  cah  wants  a  doctah!'  I  followed 
him  down  the  aisle  to  the  patient,  who  had  been  suffer- 
ing all  night  with  a  sick  headache;  she  was  retching  with 
extreme  nausea.  With  my  plexor  and  pleximeter,  I  con- 
cussed the  fifth  dorsal  spine,  which  gave  her  immediate 
relief. 

The  next  morning  after  my  arrival,  my  daughter 
came  to  me  for  relief  from  a  severe  neuralgic  pain  in  the 
left  subscapular  region,  also  extending  to  the  shoulder, 
greatly  interfering  with  motion.  Remembering  the 
therapy  that  Dr.  Abrams  taught  me  in  handling  these 
cases,  I  searched  along  the  spine  for  tender  spots  and 
found  and  froze  them  with  prompt  and  permanent  relief. 

That  same  evening  a  lady,  eight  months  enceinte 
came  into  my  office  suffering  with  PLEURODYNIA.  She 
walked  with  great  difficulty,  holding  her  hand  to  her 
side,  unable  to  stoop.  I  found  the  tender  spots  and  froze 
them  with  the  same  prompt  relief  as  in  the  preceding 
case.  As  she  was  readjusting  her  clothing,  she  was  very 
much  surprised  and  delighted  to  find  she  could  stoop  or 
bend  the  body  in  any  direction  without  pain. 

Two  cases  of  CARDIAC  ASTHMA,  in  old  men,  were 
readily  relieved  by  concussing  the  spine  of  the  seventh 
cervical.  One  old  gentleman  would  stagger  into  my 
office,  gasping  for  breath,  unable  to  talk.  As  soon  as  I 
began  to  concuss  the  spine  he  would  almost  shout  with 
ecstasy,  for  the  immediate  relief  obtained. 

At  this  writing  I  am  treating  a  case  of  EXOPHTHAL- 
MIC GOITRE,  which  came  to  me  a  few  days  ago  from 
Iowa.  She  was  recently  operated  on  at  Rochester,  Minn, 
but  received  no  benefit  (only  in  reduction  of  the  gland). 
Her  nervousness  is  much  aggravated  since  the  opera- 
tion; insomnia,  crying,  great  fear  of  impending  danger, 
hot  flushes,  choking,  etc.  With  four  treatments  of  pres- 
sure on  each  side  of  the  seventh  cervical,  she  has  calmed 

12 


Vertebral    Tenderness    and    Visceral   Diseases 

down,  sleeps  most  of  the  night,  all  symptoms  are  im- 
proved and  the  exophthalmos  is  less  pronounced. 

Other  cases  could  be  related,  but  these  are  sufficient 
for  the  scope  of  this  brief  paper.  Spondylotherapy  has 
come  to  stay;  it  is  a  help  to  the  physician  and  a  boon  to 
the  patient.  The  diagnostic  feature  of  Spondylotherapy, 
to  the  earnest  physician,  is  as  bread  to  the  hungry  man; 
mathematically  accurate,  it  is  as  a  compass  to  the  sur- 
veyor; stumbling  in  darkness,  it  is  to  us  a  bright  light. 
Every  orificial  surgeon  needs  Spondylotherapy;  it  is  a 
great  aid  to  his  work.  Great  is  Spondylotherapy." 

VERTEBRAL  TENDERNESS  AND  VISCERAL 
DISEASES. 

This  subject  has  been  fully  discussed  elsewhere  (74,  376, 
17).  The  Griffin  brothers  (2)  in  1834,  associated  spinal 
tenderness  with  certain  symptoms. 

At  one  time,  a  number  of  itinerant  physicians  relied 
solely  on  vertebral  tenderness  in  definite  regions  in  the 
diagnosis  of  disease.  This  method  of  diagnosis  was  based 
on  a  chart  (Fig.  i)  published  by  Dr.  Sherwood  in  1841,  in 
his  work,  "Motive  Power  of  Organic  Life." 

The  clinical  findings  of  Dr.  George  O.  Jarvis,  are  inter- 
esting and  are  embodied  in  the  following  contribution : 

"The  reported  cases  were  subjected  to  operation  during 
the  past  six  months.  None  are  included  except  those  in 
which  two  separate  diagnoses  were  made;  one  based  on  what 
one  might  term  'clinical'  evidence  and  the  other  determined 
by  such  reflex  signs  as  vertebral  tenderness  and  the  results 
of  percussion  by  the  vago-visceral  method  (321,  14)  of  Dr. 
Albert  Abrams.  By  'clinical'  evidence  is  meant  such  signs 
as  subjective  tenderness,  palpable  tumor,  muscular  rigidity, 
fever,  and  the  leucocyte-count. 

Nearly  all  of  the  cases  were  frozen  one  or  more  times  over 

13 


Progressive     Spondylotherapy 

the  areas  of  spinal  tenderness,  both  to  relieve  painful  symp- 
toms and  to  assist  in  diagnosis.  Freezing  over  the  Qth 
thoracic  or  2nd  lumbar  vertebra  will,  in  APPENDICITIS,  miti- 
gate the  pain  and  abdominal  tenderness.  This  relief  lasts 
from  a  few  hours  to  a  few  days  according  to  the  severity  of 
the  attack.  In  the  so-called  /PSEUDO-APPENDICITIS'  (191), 


Comcal  vertebra. 


FIG.  i. — Illustrating  Sherwood's  method  of  diagnosis  oy  pressure  along  the 
spinal  column  to  find  tenderness  at  various  points  corresponding  to  morbid  condi- 
tions of  the  organs. 

in  which  the  difficulty  is  a  lumbar  neuralgia  with  spasm  of  a 
segment  of  the  rectus  muscle,  a  few  freezings  suffice  to  cure 
as  was  pointed  out  by  Dr.  Abrams  (Loc.  Cit.}.  In  OVARIAN 
NEURALGIAS,  freezing  at  the  level  of  the  3rd  lumbar  vertebra 
produces  marked  and  immediate  relief. 

"None  of  these  cases  came  to  operation  unless  they  had 
passed  through  previous  attacks  and  were  unrelieved  by 

14 


Vertebral    Tenderness    and    Visceral    Diseases 

treatment  or  unless  the  leucocyte-count  and  other  symp- 
toms made  the  presence  of  an  abdominal  abscess  almost  cer- 
tain. Indeed,  all  those  in  whom  the  spondylo-diagnosis 
pointed  to  appendicitis,  except  two  chronic  ones  with 
thickened  appendix,  proved  to  be  pus  cases. 

The  areas  of  spinal  reflex  tenderness  were  found  to  co- 
incide with  those  ascertained  by  Dr.  Abrams  and  Dr.  Chas. 
L.  Ireland  and  are  as  follows: 

Tenderness  at  5th  and  between  5th  and  6th  thoracic 
spines,  Gastric  disease; 

Tenderness  at  loth  to  I2th  thoracic  spines,  Renal 
disease; 

Tenderness  at  nth  thoracic  and  tip  of  nth  rib,  Chole- 
cystitis; 

Tenderness  at  2nd  lumbar  on  right  side,  Appendicitis; 

Tenderness  at  8th  or  Qth  thoracic,  Appendicitis; 

Tenderness  at  3rd  lumbar  (on  side  of  disease),  Ovarian 
disease; 

Tenderness  at  4th  lumbar,  Uterine  disease; 

Tenderness  just  below  3rd  lumbar  spine  seems  to  indi- 
cate tubal  difficulty;  though  in  this  case  the  diag- 
nostic information  obtained  has  not  been  clear. 

The  area  of  spinal  tenderness  usually  extends  both 
above  and  below  the  point  or  points  of  greatest  tenderness; 
that  is,  above  and  below  the  segment  of  the  cord  with  which 
the  sympathetic  nerves  of  the  diseased  organ  communicate. 
This  is  in  accord  with  the  well-known  fact  that  irritation  of 
a  spinal  segment  which  is  either  powerful  or  prolonged  will 
produce  a  hypersensitive  state  in  the  neighboring  nerve  cells 
which  will  be  evidenced  by  pain  and  tenderness  and  some- 
times exalted  function.  This  is  noted  in  angina  pectoris.* 

*Mackenzie:    Symptoms  and  their  Interpretation. 

15 


Progressive     Spondylotherapy 

In  some  instances  of  angina,  muscular  rigidity  and  spinal 
tenderness  can  be  found  from  the  occiput  to  the  lumbar 
region  of  the  cord  and  excessive  secretion  of  saliva  is  not  at 
all  uncommon.  As  a  rule,  however,  the  points  of  greatest 
tenderness  will  be  limited  to  those  cord-segments  directly 
connected  with  the  sympathetic  nerves  supplying  the  heart. 

It  will,  be  noted  from  the  accompanying  table  that 
TUBAL  DISEASE  was  not  diagnosed  in  five  out  of  ten  cases 
by  'clinical'  methods.  OVARIAN  DISEASE  was  thought  to  be 
present  only  once  'clinically'  but  five  times  by  spondylodiag- 
nosis.  APPENDICITIS  proved  at  operation  to  be  the  only 
difficulty  in  six  out  of  twelve  cases.  In  the  other  six  it  was 
associated  with  and  may  have  been  caused  by  pus  in  the 
Fallopian  tubes. 

In  one  case  appendicitis  was  missed  'clinically'  and 
diagnosed  by  spinal  tenderness;  while  in  another,  it  was 
thought  to  be  present  by  'clinical'  methods  and  declared  to 
be  absent  by  spondylodiagnosis.  In  both  instances  the 
reflex  findings  were  found  correct  at  operation. 

One  case,  the  nature  of  which  was  not  determined 
clinically  except  that  there  was  a  pathologic  condition  in  the 
abdomen  demanding  surgical  intervention,  was  correctly 
diagnosed  by  extreme  tenderness  at  the  right  side  of  the 
fifth  thoracic  vertebra  as  perforated  gastric  ulcer,  probably 
located  in  the  pylorus  posteriorly,  "j" 

It  may  be  thought  that  such  wide  errors  in  diagnosis  as 
are  here  recorded  are  scarcely  permissible;  but  this  is  not  an 
apology — it  is  a  statement  of  fact." 


tit  is  often  possible  to  locate  in  consequence  of  unilateral  vagal  hyperesthesia  (504) 
the  site  of  gastric  lesions  (anterior  or  posterior  stomach-wall)  by  recalling  that 
the  right  vagus  innervates  the  posterior  and  the  left  vagus  the  anterior  sur- 
face of  the  stomach. 


16 


Reflexo-Clinical  Table  of  Vertebral   Tenderness 


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18 


Reflex o-Clinical  Table  of  Vertebral  Tenderness 


REMARKS 

ze,  shape,  and  position  of  gall-bladder 
found  at  operation  to  tally  with  re- 
sults of  percussion  by  vago-visceral 
method. 

terine  disease  missed  by  clinical  diag- 
nosis. 

ersistent  pain  at  2  lumbar  for  6  weeks 
after  operation  relieved  by  one  freez- 
ing. 

his  case  would  have  been  hard  to 
diagnose  without  vertebral  tender- 
ness; which  was  so  marked  that 
patient  jumped  from  bed  when  the 
S  thoracic  was  pressed  upon. 

ze,  shape  and  position  of  gall-bladder 
found  by  vago-visceral  method  of 
percussion  found  correct  at  operation. 

umbar  muscles  rigid  on  right  side. 
Case  diagnosed  by  cystoscopy  and 
segregation  of  urine.  Outline  of  kid- 
ney determined  by  percussion  found 
correct  at  operation  (350,  630). 

enderness  at  2  lumbar  did  not  develop 
till  2  weeks  after  first  examination 
while  waiting  for  an  interval  to 
operate. 

his  case  was  really  operated  for 
hernia;  the  nephrorrhaphy  was  only 
incidental. 

^ze,  shape  and  position  of  gall-bladder 
determined  by  vago-visceral  percus- 
sion found  to  be  correct  at  operation. 

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The      Circulatory      System 

Dr.  Jarvis  formulates  the  ensuing  conclusions  respecting 
his  observations: 

1.  Of  the  30  cases  in  about  30  per  cent  the  "clinical" 
diagnosis  was  incorrect  as  to  the  organ  affected,  though  cor- 
rect as  to  the  presence  of  some  difficulty  requiring  surgical 
intervention. 

2.  In  no  case  would  conclusions  based  on  the  spondylo- 
diagnosis  have  led  one  astray  as  to  the  organ  involved; 
although  it  is  difficult  to  decide  from  the  reflex  findings  be- 
tween an  ovarian,  a  tubal,  and  a  tubo-ovarian  affection. 

3.  Spondylodiagnosis  alone  does  not  usually  yield  a 
complete  pathologic  diagnosis;  but  it  does  accurately  point 
out  which  organ  is  involved  and,  in  connection  with  other 
"clinical"  findings,  permits  of  the  greatest  accuracy. 

THE  CIRCULATORY  SYSTEM. 

ANGINA  PECTORIS.* — Dr.  George  O.  Jarvis  (Ashland, 
Oregon),  in  a  study  of  this  subject  observes  that  the  phenom- 
ena accompanying  an  attack  have  received  little  accurate 
study  for  the  reason  that  the  patients  are  in  such  stress  that 
circumstances  demand  definite  action  rather  than  deliberate 
consideration. 

After  occlusion  of  a  large  branch  of  the  coronary  artery, 
blood-pressure  falls  and  the  myocardium  passes  into  a  state 
of  fibrillation  (delirium  cordis). 

In  all  fatal  cases  of  angina,  Osier  finds  a  chronic  endarte- 
ritis  with  narrowing  of  the  openings  of  the  coronary  vessels, 

Fibrillation  is  the  result  of  a  block  produced  by  inter- 
ference with  the  nutrition  of  a  considerable  part  of  the 
myocardium.  A  like  condition  may  be  evoked  by  freezing 
the  apex  of  the  ventricle  or  by  stimulating  the  surface  of  the 

*Note  the  author's  classification  of  angina  pectoris  (539). 
21 


Progressive     Spondylotherapy 

ventricle  at  a  rate  greater  than  that  which  can  be  taken  up 
by  the  ventricle  as  a  whole. 

One  may  assume  that  during  a  paroxysm  there  is  not  a 
sufficient  blood-supply  to  the  myocardium  but  this  does  not 
take  into  account  the  fact  that  vagal  tone  (445)  is  progres- 
sively exhausted  and  is  diminished  in  the  interparoxysmal 
periods. 

One  often  finds  very  low  blood-pressure  (under  100) 
when  the  patient  is  recovering  from  a  seizure. 

If  the  cause  of  angina  were  only  a  mechanic  obstruction 
in  the  coronary  arteries  then  measures  to  improve  vagal  tone 
would  fail  to  relieve  the  suffering  and  we  could  not  under- 
stand why  emotions  are  more  frequent  provocative  factors 
of  an  attack  than  physical  exertion.  Emotions  and  physical 
exertion  by  augmenting  adrenalin  in  the  blood  (33)  decrease 
the  tone  of  the  vagus. 

Asthma  is  associated  with  hypertonia  of  the  vagus  and 
adrenalin  hypodermically  by  decreasing  vagus-tone  will 
abort  an  attack  (314). 

On  the  contrary,  by  augmenting  vagus- tone,  one  may 
precipitate  an  attack  of  asthma  (494). 

One  finds  after  an  attack  of  angina  and  between  the  at- 
tacks, diminished  vagus- tone  (10). 

In  all  cases  of  angina  examined  by  Dr.  Jarvis  during  an 
attack,  cardiac  dilatation  could  be  demonstrated  and  the 
relief  of  pain  coincided  with  the  regression  of  the  dilatation. 
In  all  the  cases  auricular  fibrillation  was  present. 

The  following  may  be  cited  as  a  typic  case  of  angina: 

The  patient  was  a  woman  of  72  years,  five  feet  and 
one  inch  in  height,  weighing  100  pounds.  There  was 
slight  emphysema  of  the  lungs,  marked  visceral  ptosis, 
constipation,  and  indigestion. 

The  urine  shows  %  per  cent,  albumin,  fatty  casts, 

22 


The       Circulatory      System 


and  has  a  specific  gravity  of  1015  to  1022.  The  amount 
in  24  hours  is  between  25  and  30  ounces. 

The  case  was  diagnosed  by  two  other  physicians  as 
angina  pectoris.  She  had  a  number  of  attacks  during 
the  past  ten  years.  These  attacks  follow  mental  or 
physical  exhaustion  and  shock  and  are  sometimes  pre- 
ceded by  a  premonitory  dizziness.  There  is  a  sudden 
onset,  she  falls  to  the  ground,  and  fears  to  move  lest  she 
die.  There  is  acute,  sometimes  agonizing  pain  in  the  left 
arm  and  shoulder.  The  lips  become  swollen  and  dusky, 
the  face  drawn,  great  dyspnoea  with  distention  and  pul- 
sation of  the  veins  of  the  neck  ensues.  The  liver  is 
swollen  and  may  be  felt  to  pulsate.  There  is  pain  and 
oppression  in  the  left  chest  with  a  feeling  of  weight  and  a 
choking  sensation  in  the  throat. 

The  pulse  increases  in  rapidity  till  it  beats  140  or 
145  per  minute. 

After  the  attack  has  progressed  for  a  short  time,  the 
skin  and  muscles  over  the  left  chest,  and  inner  side  of  the 
left  arm,  and  the  left  side  of  the  neck  become  painful 
and  tender  to  pressure. 

The  blood-pressure  is  high.  In  one  attack  it  was 
when  first  taken  220;  it  then  dropped  to  215;  rose  again 
to  220;  once  more  dropped  to  210.  It  averaged  through- 
out the  first  half  hour  about  215.  Just  after  the  attack 
the  blood-pressure  was  155  and  the  pulse,  which  was 
more  rapid  the  higher  the  blood-pressure,  and  ran  from 
120  to  140,  had  dropped  to  82  per  minute. 

During  the  time  when  the  pulse  was  beating  140 
per  minute  there  would  be  an  occasional  slow  ventricular 
beat;  though  the  auricle  was  in  fibrillation  from  the  be- 
ginning to  the  end. 

The  transverse  diameter  of  the  heart  was  18  cm. 
when  seen  the  day  after  an  attack  at  a  time  when  the 
pulse  was  90  per  minute  and  was  considerably  greater 
during  the  pains;  dilating  till  it  seemed  to  fill  the  whole 
chest  with  irregular,  heaving  waves  of  pulsation. 

Heart-block  and  irregular  heart-beat  were  found  in 

23 


Progressive     Spondylotherapy 

all  cases  which  1  examined  and  in  one  case  which  I  saw 
about  a  year  ago,  the  pulse  was  so  slow  that  I  believed 
there  was  a  'spasm  of  the  heart  muscle'  or  'spasm  of  the 
coronary  arteries'; — 'spasms'  which  I  now  believe  to  be 
non-existent.  On  examining  the  same  patient  in  a  sub- 
sequent attack  it  was  found  that  the  auricle  was  enor- 
mously dilated  and  in  a  state  of  fibrillation.  The  ven- 
tricle was  also  dilated  though  not  to  the  same  degree  as 
the  auricle.  The  pulse  was  rapid — no  to  125;  but  with 
periods  of  slow  pulse— 50  to  60  per  minute. 

It  was  found  that  heart-irregularity  increased  and 
decreased  pari  passu  with  the  increase  and  decrease  of 
the  dilatation;  so  that  there  was  a  relation  between  the 
amount  of  distention  of  the  heart  and  the  degree  of  its 
irregularity. 

a,  When  it  was  attempted  to  reduce  the  cardiac  dilata- 
tion by  concussion  at  the  seventh  cervical  vertebra,  ac- 
cording to  the  method  of  Dr.  Abrams'  (Spondylotherapy), 
it  was  found  that  concussion  for  one  minute  produced 
much  less  proportionate  effect  than  the  same  amount  of 
concussion  would  in  patients  whose  hearts  are  dilated 
but  who  were  not  at  the  time  in  an  anginal  paroxysm,  or 
in  the  same  patients  during  the  interval  between  attacks. 

The  woman  whose  case  I  have  just  instanced,  re- 
quired morphin  in. doses  of  %  gram  repeated  two  or 
three  times  to  relieve  the  pains  in  the  arm  and  chest 
during  the  more  severe  seizures  and  even  with  this 
amount  the  pain  lasted  for  several  hours. 

Concussion  at  the  seventh  cervical  vertebra  employed 
during  the  attack  reduced  the  diameter  of  the  heart  5 
cm.  and  of  the  aortic  bow  4  cm.  on  two  separate  occa- 
sions with  relief  of  pain  in  about  10  minutes,  so  that  the 
patient  soon  fell  asleep  without  the  administration  of 
any  hypnotic. 

Concussion  was  more  prompt  and  efficient  for  relief 
of  pain  than  morphin.  Concussion  alone  was  not  as 
efficient  as  concussion  combined  with  a  hypodermic  of 
i-io  grain  of  pilocarpin  (grams  0.0065).* 

*Vide  pages  451.  522,  590. 

24 


The      Circulatory      System 

Pain  and  tenderness  which  persisted  after  the  cessa- 
tion of  the  actual  attack  were  relieved  by  freezing  at  the 
level  of  the  cord  which  connected  with  the  sympathetic 
nerves  of  the  heart. 

Conclusions: 

1.  All  cases  of  angina  pectoris  which  I  have  had  the 

opportunity  to  examine  showed  marked  dilata- 
tion of  the  heart  with  auricular  fibrillation. 

2.  The  cause  is  arterial  disease  with  blocking  of  the 

coronary  arteries.  Associated  with  this  is  a  vagal 
hypotonia  which  becomes  more  marked  the 
longer  the  attack  lasts. 

3.  The    blood-pressure  is    high  at  the  beginning, 

sometimes  dropping  to  100  mm.  or  less  at  the 
close. 

4.  The  pains  are  due  to  a  viscero-sensory  reflex  and 

may  be  relieved  by  freezing  at  the  appropriate 
areas  of  the  spine. 

5.  The  most  efficient  method  [of  treatment  is  by 

concussion  at  the  level  of  the  seventh  cervical 
vertebra,  associated  with  the  hypodermic  use  of 
some  drug  such  as  pilocarpin  to  increase  vagus 
tone." 

The  author  has  found  that  in  MYOCARDIAL  INSUFFIC- 
IENCY, the  ingestion  of  cold  water  will  dilate  the  heart.  This 
explains  anginoid  symptoms  after  or  during  the  ingestion  of 
food. 

Dr.  J.  A.  Hirsch  (Edwardsville,  111.)  has  successfully 
treated  ANGINOID  PAINS  by  concussion  of  the  four  lower  dor- 
sal spines  (227). 

The  same  writer  reports  a  case  of  PALPITATION  due  to 
motor  insufficiency  and  dilatation  of  the  stomach  in  which 
the  attacks  were  relieved  by  concussion  of  the  5th  dorsal 
spine  to  open  the  pylorus  (83)  and  the  patient  was  cured  by 
concussion  of  the  first  three  lumbar  spines  to  overcome  the 
motor  insufficiency  of  the  stomach  (317). 

25 


Progressive     Spondylotherapy 

Dr.  Hirsch  also  reports  a  patient  with  TACHYCARDIA 
who  was  cured  by  concussion  of  the  yth  cervical  spine.  The 
duration  of  treatment  was  one  month  (52). 

C.  and  G.  Minerbi  (Rivista  Critica  di  Clinica  Medica, 
Firenzi)  contribute  important  researches  on  the  subject  of 
the  AORTIC  REFLEXES  (254). 

CARDIAC  INSUFFICIENCY. — The  author's  treatment  of  this 
affection  has  already  been  noted  (510  et  seq.}. 

Dr.  J.  A.  Hirsch,  reports  a  case  of  MITRAL  INSUFFICIENCY 
with  cardiac  dilatation  which  was  symptomatically  cured  by 
concussion  of  the  7th  cervical  spine. 

Dr.  Edward  S.  Smith  (Bridgeport,  Conn.),  reports  a  case 
of  cardiac  dilatation  with  a  systolic  murmur  at  the  apex 
suggestive  of  mitral  insufficiency  which  disappeared  per- 
manently after  one  treatment  by  concussion  of  the  yth  cervi- 
cal spine  (525). 

Dr.  Myer  Solis-Cohen  (Philadelphia),  reports  as  follows: 
"A  pathetic  incident  occurred  at  the  'Philadelphia  General 
Hospital'  last  winter.  While  contracting  the  heart  of  a 
patient,  I  noticed  a  patient  with  CARDIAC  ASTHMA  in  the 
next  bed  fighting  for  breath.  Three  minutes  percussion  (at 
the  7th  cervical  spine)  gave  the  latter  complete  relief.  I 
asked  the  resident  who  had  just  come  on  the  service,  if  I 
should  not  leave  the  hammer  with  him  for  use  in  a  subse- 
quent attack  but  he  said  he  would  rather  see  me  demonstrate 
its  use.  At  my  next  visit,  I  was  informed  by  the  nurse  that 
on  the  following  night  the  patient  had  succumbed  in  another 
dyspneic  paroxysm  and  clamored  for  the  hammer  which 
was  not  obtainable." 

HEART  REFLEX  (Influence  of  posture). — Reference  has 
been  made  to  the  heart  reflexes  (199  et  seq.}.  The  cardiac 
sign  of  Gordon  (Brit.  Med.  Jour.,  May  31,  1913)  in  CANCER 

26 


The      Circulatory      System 

has  prompted  me  to  study  the  amplitude  of  the  heart  reflex 
of  contraction  as  influenced  by  posture. 

Gordon's  sign  consists  in  a  great  diminution  of  the  cardiac 
dulness  in  the  recumbent  posture  as  determined  by  digital 
percussion.  In  a  patient  with  cancer,  the  cardiac  dulness 
in  the  recumbency  begins  above  about  the  4th  or  5th  costal 
cartilage,  has  its  right  margin  one-half  or  one  inch  to  the  left 
of  the  mid-sternal  line,  and  measures  across  less  than  2  inches 
at  the  level  of  the  5th  costal  cartilage.  In  many  cases  it 
measures  less  than  one  inch  across.  In  many  cases  there  is  no 
cardiac  dulness  at  all.  In  1908  the  author  studied  a  series  of 
103  cases,  in  all  of  which  there  was  suspicion  of  cancer.  In 
38  of  these  cases,  in  which  a  presumable  cancer  was  accessible 
to  direct  examination,  or  was  examined  at  operation,  or  post- 
mortem, 89  per  cent,  showed  the  cardiac  sign.  In  46  cases 
which  were  not  supposed  to  be  cancerous,  it  was  present 
only  in  24  per  cent,  of  cases.  In  another  recent  series  of  107 
cases,  it  was  demonstrated  that,  whereas  in  cancerous  cases 
the  sign  is  present  in  a  very  large  majority,  in  non-cancerous 
cases  it  is  even  rarer  than  the  first  series  suggest. 

Gordon's  explanation  of  the  phenomenon  is  unsatisfac- 
tory. It  is  most  probably  caused  by  the  elicitation  of  the 
heart  reflex  of  contraction  by  the  negative  discharge  of 
energy  from  carcinomata  (84  et  seq.). 

Why  is  the  reflex  in  question  only  in  evidence  in  the 
recumbent  posture?  My  investigations  demonstrated  that 
the  heart  reflex  when  evoked  has  double  the  amplitude  in  the 
recumbent  than  in  the  erect  posture  owing  to  the  fact  that 
the  tone  of  the  cardiac  musculature  in  recumbency  is  rela- 
tively diminished  and  in  consequence  it  more  readily  re- 
sponds to  influences  which  evoke  the  reflex. 

The  foregoing  fact  is  of  importance  in  cardiotherapy 
when  it  is  necessary  to  elicit  the  reflex  in  question.  Thus, 

27 


Progressive     Spondylotherapy 

in  the  treatment  of  cardiac  dilatation  the  results  are  more 
effective  and  rapid  when  concussion  of  the  yth  cervical  spine 
is  executed  during  recumbency. 

AUGMENTED  BLOOD-PRESSURE. — Blood-pressure  has  al- 
ready received  consideration  (234,  53). 

In  women  pressure  is  approximately  1015  mm.  lower 
than  in  men.  In  athletic  men  it  may  be  10-15  mm.  higher 
than  in  moderate  development. 

Normal  pressure  may  be  roughly  estimated  by  allowing 
i  mm.  of  mercury  for  every  year  after  the  age  of  15  and 
adding  100  to  the  number.  Thus,  in  a  patient  whose  age  is 
60,  one  should  expect  a  normal  pressure  of  160  mm.  Reduc- 
tion of  hypertension  is  not  always  indicated  as  is  illustrated 
by  the  following  case: 

An  individual  has  a  blood-pressure  of  260  mm. 

In  his  case  renal  insufficiency  is  present. 

In  estimating  the  urea  in  the  urine,  one  must  remember 
that  its  percentage  varies  with  the  amount  of  proteid  food 
ingested.  Before  concluding  that  the  urea  is  diminished 
(hypoazoturia)  an  ample  mixed  diet  must  be  given. 

If  during  one  day  a  test  diet  of  500  grams  of  meat,  8  eggs 
and  200  grams  of  bread  (a  total  of  172.25  grams  of  proteid)  is 
given,  the  excretion  of  urea  in  the  norm  should  be  59  grams. 

This  amount  of  urea  was  excreted  in  our  patient  with  a 
pressure  of  260  mm.  When  the  latter  was  reduced  to  200 
mm.  the  amount  of  urea  excreted  with  the  diet  in  question 
amounted  to  30  grams  and  the  patient  suffered  from  minor 
symptoms  of  uremia.  By  aid  of  a  purin-free  diet  only,  the 
pressure  fell  to  220  mm. 

Rest  in  bed  is  one  of  the  most  important  aids  in  the 
treatment  of  the  hypertensionist.  One  not  infrequently 
observes  that  an  individual  having  a  blood-pressure  of  200 
mm.  or  more,  when  up  and  about  may  show  a  pressure  of 

28 


The       Digestive      System 

140  mm.  or  less  when  at  rest  in  bed.  This  is  important 
insomuch  as  continued  hypertension  may  conduce  to 
arteriosclerosis. 

Relative  to  the  permanency  of  results  secured  in  hyper- 
tension by  concussion  (249),  Dr.  H.  C.  Sawyer  (San  Fran- 
cisco), reports  the  following  case: 

"Widow  62.  Had  hyperchlorhydria,  polyneuritis 
and  a  blood-pressure  of  210  mm.  Was  treated  for  many 
months  at  a  sanatorium  by  rest,  diet,  Nauheim  baths, 
etc.,  without  any  result  in  bringing  the  pressure  at  any 
time  below  160  mm. 

Concussion  executed  every  other  day  between  the 
3rd  and  4th  dorsal  spines  for  two  months  eventuated  in 
a  reduction  of  pressure  ranging  from  128-130  mm. 
where  it  has  remained  permanently  for  one  year  (the  pres- 
ent time  of  writing), 'excepting  that  on  several  [occasions 
after  emotions  the  pressure  rose  to  140-145  mm.  for  a 
day,  returning,  however,  to  130  mm." 

THE  DIGESTIVE  SYSTEM. 

Dr.  F.  J.  Roemer  (Waukegan,  111.),  reported  the  follow- 
ing anamnesis  of  PSETJDODYSPEPSIA  (197),  which  I  shall  per- 
mit him  to  tell  in  part  in  his  own  inimitable  wTay: 

"Any»pain,  the  cause  of  which  cannot  definitely  be  located 
is  called  rheumatism;  so  also,  any  trouble,  ache,  pain,  or 
discomfort  near  the  epigastrium  is  called  stomach  trouble, 
and  if  we  are  entirely  at  sea  and  have  lost  chart  and  compass, 
or  rather  never  had  them  we  say :  'Oh,  that  is  Reflex-stomach 
trouble?  or  'Nervous  dyspepsia.'  But  really,  diseases  of  the 
stomach  have  been  divided  into  two  great  branches: 

First.    Such  that  we  know  all  about; 

Second.    Such  that  we  ought  to  know  all  about. 

The  diseases  of  the  second  branch  are  in  the  majority 
and  are  called: 

29 


Progressive     Spondylotherapy 

'Nervous  diseases  of  the  stomach'  The  etiology,  path- 
ology and  symptomatology  of  this  great  branch  can  be 
found  (?)  in  any  of  the  latest  and  best  books  on  stomach 
diseases. 

I  am  reporting  just  one  case : 

"Miss  M.  had  been  complaining  of  a  pain  in  the  ex- 
treme north-west  corner  of  the  left  lumbar  region  for  at 
least  thirteen  years.  Pain  like  a  ball  pressing  there, 
which  would  increase  gradually  for  twenty-four  hours  in 
severity.  When  pain  was  at  its  height,  vomiting  of  in- 
gested food  if  recently  taken,  or  just  glairy  water  or 
mucus  ensued,  which  gave  slight  relief  for  a  time.  The 
attacks  would  last  from  two  days  to  two  weeks,  and 
were  modified  by  rest  and  aggravated  by  work  or  even 
by  walking.  If  an  attack  were  subsiding  and  she  got  on 
her  feet  too  soon  the  pain  was  increased  and  all  the 
symptoms  returned.  She  had  to  be  careful  of  what  she 
ate  and  how  she  ate  it.  (At  least  she  thought  so.)  Hot 
dry  applications  gave  some  relief.  Any  food  or  liquid, 
either  hot  or  cold,  would  be  immediately  vomited  if  taken 
while  pain  was  present. 

At  times  she  would  go  for  six  months  without  an 
attack ;  during  which  time  there  was  no  pain  from  eating 
or  drinking  but  a  continual  nauseous  feeling  as  though  it 
might  be  easy  to  vomit,  although  she  would  not  vomit. 
There  was  no  particular  pain  in  stomach  or  anywhere 
else.  She  never  could  tell  what  precipitated  an  attack. 
On  lying  down  or  when  lifting  heavy  objects  she  had 
noticed  a  pain  in  her  back  in  the  lower  dorsal  and  upper 
lumbar  region, with  discomfort  in  back  present  all  the  time, 
but  it  never  seemed  to  get  worse  at  time  of  pain  in  abdo- 
men, so  it  was  never  thought  of  in  connection  with 
abdominal  trouble. 

It  had  become  very  much  worse  for  the  last  three 
or  four  years,  although  she  had  been  treated  by  many 
prominent  men  who  diagnosticated  her  trouble  as 
splenic,  ovarian  colonic,  etc.,  etc.  The  treatment  ranged 

30 


The      Digestive      System 

from  osteopathy,  pure  and  simple,  to  morphin  straight, 
and  the  patient  was  getting  no  better.  Returning  to  my 
office  and  having  discovered  areas  of  vertebral  tenderness 
incident  to  a  spinal  neuralgia,  I  sprayed  her  back  three 
times  and  on  the  fourth  morning  I  asked  her  how  she 
felt  and  the  answer  was: 

'It  is  the  first  time  in  three  years  that  I  could  eat 
my  breakfast  without  thinking  of  what  I  ate  and  how  I 
ate  it.  I  enjoy  eating  once  more.'  And  then  the  office 
girl  gasped — 'Well,  how  did  you  do  it?' 

A  repetition  of  freezing  several  times  eventuated  in 
absolute  relief  of  the  symptoms." 

Why  do  I  report  the  foregoing  under  the  head  of 
STOMACH  REFLEXES? 

"Very  evidently  the  real  reflex  to  the  stomach  was  being 
irritated  because  it  was  not  labeled  'STOMACH,'  and  because 
it  came  under  the  second  grand  division  of  diseases  of  the 
stomach,  and  because  the  men  who  had  tried  had  not  been 
able  to  interpret  the  call  of  the  tissues,  nor  had  they  been 
able  to  locate  the  real  cause;  they  thought  the  trouble  was 
where  they  thought  the  pain  was,  and  they  thought  the 
pain  was  where  the  patient  thought  it  was.  They  allowed 
the  patient  to  think  for  them,  to  diagnose  the  case,  and  they 
only  proceeded  to  give — oh,  ye  gods! — MORPHIN;  because 
•morphin  is  good  for  pain.  L.  A.  Z.  Y.  does  that  spell  it? 

They  were  honest,  honorable  men.  I  think  so;  really  I 
do.  They  were  practicing  medicine  as  she  is  taught  in  some 
colleges,  even  today. 

One  should  remember  that  often,  at  least  sometimes  pain 
is  felt  at  the  end  of  the  nerve  when  the  cause  of  the  pain  is 
near  to  or  at  the  origin  of  the  nerve;  and  loss  of  function 
comes  first,  and  a  pathological  condition  comes  second." 

THE  PYLORUS. — Paravertebral  pressure  at  the  5th  dorsal 
spine  or  concussion  of  the  latter  will  open  the  pylorus  (588, 
82)  and  cause  the  stomach  to  assume  a  vertical  position. 

31 


Progressive     Spondylotherapy 

In  Chicago,  this  was  recently  demonstrated  fluoroscopi- 
cally  by  Dr.  Patrick  S.  O'Donnell.  The  latter  observes  that 
after  the  ingestion  of  the  conventional  bismuth  meal,  it  takes 
approximately  one  hour  and  fifteen  minutes  for  the  stomach 
to  void  its  contents,  whereas  after  concussion  of  the  5th 
dorsal  spine,  the  stomach  voids  the  bismuth  in  i%  minutes. 

Lebon  and  Aubourg  recently  presented  before  the 
"Soci£&  de  Radiologie  Medicale  de  Paris"  comparative 
radiographs  showing  modifications  of  the  large  intestine 
after  concussion  of  the  spinous  processes  of  the  lumbar  ver- 
tebrae. They  also  show  that  vertebral  reflexotherapy  (639) 
has  given  good  results  in  CONSTIPATION. 

They  had  ascertained  upon  administering  castor  oil,  then 
a  bismuth  suspension,  and  finally  examining  the  subject 
with  the  x-rays,  that  electrical  stimulation  of  the  right  pneu- 
mogastric  nerve  in  the  neck  caused  contractions  of  the  as- 
cending colon,  sufficiently  marked  to  be  plainly  visible  on 
the  screen  at  each  excitation  of  the  nerve.  Similar  stimula- 
tion of  the  crural  or  sciatic  nerves  produced  little  or  no  change 
in  the  colon.  Upon  applying  one  electrode  to  the  right  pneu- 
mogastric  and  introducing  the  other  into  the  stomach  as  a 
sound,  spasm  of  the  ascending  colon  occurred.  Vigorous 
percussion  of  the  seventh  cervical  spinous  process  was  found 
to  cause  the  cecum  to  rise  and  the  ascending  colon  to  become 
broader;  such  effects  were  observed  in  all  persons  examined 
except  one — a  woman  with  marked  enterospasm  and  con- 
stipation. Percussion  of  the  dorsal  spines  had  no  effect  on 
the  colon  until  the  lowest  ones  were  reached;  percussion  of 
these,  or  of  the  lumbar  spines,  brought  about  contractions 
of  the  colon  in  all  its  divisions. 

GALL-BLADDER. — The  location  of  this  structure  by  new 
methods  of  percussion  (598,  p£),  has  received  repeated  con- 
firmation. Dr.  Laurence  Selling  (Portland,  Oregon)  reports 

32 


TA 


D 


igestive 


S  y 


stem 


as  follows;  "Only  a  few  days  ago,  I  had  occasion  to  observe 
the  value  of  gall-bladder  percussion  by  your  method.  The 
patient  was  a  woman  who  had  been  having  indefinite 
abdominal  symptoms  for  months  with  occasional  presence 
of  bile  in  the  urine.  An  abdominal  examination  was  abso- 
lutely negative.  The  gall-bladder  was  enlarged  as  demon- 
strated by  percussion.  The  operation  confirmed  the  per- 
cussion-findings; the  gall-bladder  was  enlarged  due  to  the 
impaction  of  a  large  calculus  at  the  opening  of  the  cystic 
duct." 


FIG.  2. — The  upper  illustration  shows  how  the  erect  posture  of  man  forces  the 
heart  to  pump  against  gravity  whereas  in  the  lower  figure  the  work  of  the  heart  is 
minimized. 


GALL-STONE  COLIC. — Dr.  D.  V.  Ireland  (Wilmington,  O.), 
reports  the  following  case:  "In  November,  1912,  I  was 
called  to  see  a  patient  suffering  from  gall-stone  colic  who  had 
heretofore  only  found  relief  by  means  of  hypodermatic  in- 
jections of  morphin. 

Concussion  of  the  4th  to  the  6th  dorsal  spines  with  the 
object  of  contracting  the  gall-bladder  (599)  was  executed 
and  within  five  minutes  the  pain  was  arrested.  Within  48 

33 


Progressive      Spondylotherapy 

hours  she  had  a  recurrence  of  the  paroxysm  which  was  simi- 
larly influenced." 

SPLANCHNIC  NEURASTHENIA. — Augmented  experience 
of  the  author  demonstrates  the  frequency  of  this  affection 
and  there  is  perhaps  no  one  who  does  not  show  some  minor 
manifestation  of  this  affection  however  varied  may  be  its 
expression.  The  postural  mechanism  of  the  human  is  so 
complex  that  it  demands  an  enormous  amount  of  energy  to 
keep  it  upright. 

Our  simian  ancestors  with  vessels  horizontal  and  nearly 
on  a  level  walking  on  all  fours  (Fig.  2)  put  relatively  little 
strain  on  the  heart.  The  erect  posture  of  man  (Fig.  2) 
forces  the  heart  to  pump  blood  against  gravity. 

MISCELLANEOUS  DATA. 

POLIOMYELITIS. — Dr.  W.  B.  Ryder  (Clinton,  la.j,  pre- 
sents the  following  report  concerning  five  patients  with  this 
disease  who  were  treated  by  the  methods  of  spondylotherapy : 

Two  sisters  (10  and  14  years  of  age)  afflicted  syn- 
chronously. The  younger  had  complete  paralysis  of  the 
arm.  Concussion  primarily  over  4th,  5th,  6th  and  yth 
cervical  spines  followed  later  by  use  of  sinusoidal  current 
to  the  same  area.  Result:  absolute  restoration  of  the 
arm  two  months  later.  The  other  sister  had  complete 
paralysis  of  both  lower  limbs.  Like  treatment  employed 
over  8th  to  nth  dorsal  spines.  Absolute  restoration  of 
the  affected  extremities. 

Equally  good  results  ensued  in  a  girl  with  involve- 
ment of  the  right  lower  extremity  and  in  a  boy  after  one 
month's  treatment." 

At  the  same  tune  in  an  epidemic  in  Clinton,  two  patients 
who  were  under  the  care  of  other  physicians,  one  is  wearing 
an  orthopedic  apparatus  and  the  other  gets  around  by  means 
of  a  chair  and  is  unable  to  walk. 

34 


Miscellaneous        Data 

TRIGEMINAL  NEURALGIA. — Dr.  G.  O.  Jarvis  (Ashland, 
Oregon),  referring  to  the  treatment  of  this  affection  alludes 
to  the  fact  that  if  there  is  a  central  factor  in  trigeminal  neu- 
ralgia (374,  414,  j#),  a  tender  spot  will  be  found  over  the 
great  occipital  nerve  just  behind  the  mastoid  process  and 
also  occasionally,  over  the  two  upper  cervical  vertebrae. 

"No  other  nerve  in  the  body  has  such  an  extensive  deep 
origin  in  the  brain  as  the  trigeminus — its  nuclei  of  origin 
reach  from  the  upper  part  of  the  mesencephalon  above  to  the 
upper  end  of  the  column  of  cells  which  constitute  the  sub- 
stantia  gelatinosa  Rolandi  of  the  cord.  This  nucleus  is  at 
the  level  of  the  second  cervical  vertebra. 

The  first  posterior  division  of  the  spinal  nerves  is  rudi- 
mentary or,  occasionally,  altogether  absent,  but  the 
second — the  great  occipital  nerve — is  larger  than  the 
corresponding  anterior  division  and  furnishes  us  a  route 
along  which  we  may  influence  the  upper  segments  of  the 
cord. 

Dr.  Albert  Abrams,  of  San  Francisco,  was  the  first  to 
place  treatment  of  neuralgic  affections  by  means  directed  to 
the  central  portion  of  the  nervous  system  on  a  scientific  basis. 
He  showed  that  a  number  of  supposedly  surgical  abdominal 
affections  are  actually  neuralgic  in  character  and  that  they 
yield  to  freezing  applied  at  the  appropriate  level  of  the  spine. 

Neuralgia  of  the  spinal  nerves  is  much  more  amenable  to 
this  or  any  other  treatment  than  neuralgia  of  the  fifth  nerve, 
but  Dr.  Abrams  suggested  freezing  over  the  site  of  the  Gas- 
serian  ganglion,  just  above  the  zygoma,  and  also  over  the  two 
upper  cervical  vertebras  in  trigeminal  pain.  He  advises,  in 
addition  to  the  freezing,  the  use  of  the  slow  sinusoidal  cur- 
rent applied  with  one  pole  over  the  site  of  the  Gasserian 
ganglion  and  the  other  over  the  upper  cervical  vertebrae.  As 

35 


Progressive     Spondylotherapy 

everyone  does  not  possess  a  sinusoidal  apparatus  freezing  is 
of  more  general  service. 

Freezing  is  done  as  follows:  Ether  is  sprayed  on  the 
part  to  be  frozen,  from  an  atomizer,  operated  either  by  hand 
or  by  compressed  air.  Trial  has  shown  that  Malinkrodt's 
ether  is  perhaps  the  best  made  for  this  purpose.  If  the  air 
contains  much  moisture  it  may  be  necessary  to  start  the  freez- 
ing with  a  little  ethyl  chlorid  sprayed  on  before  the  ether  is 
begun.  Dr.  W.  T.  Baird,  of  El  Paso,  Texas,  employs  a  chunk 
of  ice,  dipped  in  salt,  and  pressed  against  the  point  of  verte- 
bral tenderness  for  about  three  minutes.  The  depression  left 
may  then  be  frozen  with  ether  spray.  Dr.  Guild,  of  Des 
Moines,  Iowa,  says  that  this  method  is  superior  to  that  with 
ether  spray  as  it  may  be  maintained  for  a  longer  time  and 
with  less  sloughing  or  desquamation. 

Freezing  should  be  done  thoroughly  and  continued  for 
two  or  more  minutes,  and  repeated  at  intervals  of  three  or 
four  days  till  the  desired  effect  is  produced.  The  frozen  skin 
will  become  hyperemic  and  a  little  sore,  so  that  it  may  be 
necessary  to  wait  some  days  between  treatments.  Painting 
the  skin  after  f reezing  with  collodion  mitigates  somewhat  this 
skin  irritation  and,  by  freezing  over  the  collodion  at  the  next 
sitting,  a  second  treatment  may  be  applied  sooner  than  would 
otherwise  be  the  case. 

The  great  occipital  on  the  affected  side  is  the  more  ten- 
der and  treatment  will  be  first  directed  to  that  point;  but, 
from  the  fact  that  both  great  occipital  nerves  are  connected 
with  the  same  cord  segments,  freezing  on  either  side  will  pro- 
duce a  similar — though  not  as  marked — effect.  This  point 
may  be  remembered  with  advantage  if  one  desires  to  apply 
the  method  frequently  and  yet  fears  the  skin  irritation  pro- 
duced by  rapidly  repeated  freezings. 

In  freezing  over   the'  site   of   the  Gasserian  ganglion, 

36 


Miscellaneous        Data 

which  is  a  decidedly  more  painful  procedure  than  over  the 
spinal  centers,  one  cannot  make  use  of  either  side  at  will,  but 
is  compelled  to  spray  over  the  affected  side." — (The  Pacific 
Dental  Gazette,  August,  1913).  In  a  more  recent  communi- 
cation (Pacific  Dental  Gazette,  December,  1913),  Jarvis  and 
Endelman,  comment  on  the  employment  of  freezing,  which 
for  promptness  and  efficiency  is  surpassed  by  no  other 
therapeutic  or  operative  method  in  the  treatment  of  pain 
of  dental  origin,  or  any  structure  of  the  face  innervated  by 
the  trigeminus. 

In  post-extraction  pain,  the  freezing  method  acts  as  if 
by  magic.  Their  conclusions  are  based  on  a  series  of  200 
cases  of  pain  of  varied  degrees  of  intensity 

When  the  pain  arises  in  the  lower  teeth,  the  area  to  be 
frozen  lies  behind  the  ear  at  about  one-half  inch  behind 
the  posterior  border  of  the  mastoid  process.  This  post- 
mastoid  area  is  frozen  to  an  area  corresponding  to  the  size 
of  a  fifty  cent  piece.  If  pain  arises  in  the  upper  teeth,  the 
latter  area  in  addition  to  an  anterior  auricular  area  (in  front 
of  the  ear  about  three-quarters"  of  an  inch  from  the  tragus) 
is  frozen.  This  technique  applies  to  any  neuralgia  of  the 
trifacial  nerve. 

Dr.  W.  A.  Guild  (Des  Moines,  Iowa),  comments  on  the 
great  value  of  freezing  in  the  treatment  of  neuralgic  affec- 
tions but  emphasizes  the  fact  that  its  specificity  can  only  be 
realized  in  uncomplicated  neuralgia  and  when  freezing  is 
executed  near  the  point  of  origin  of  the  involved  nerve  close 
to  the  site  of  the  lesion. 

CEREBRASTHENIA. — Dr.  W.  T.  Baird  (Chicago),  presents 
an  interesting  paper  on  this  subject  and  directs  attention  to 
the  important  part  played  by  the  splanchnic  circulation 
(346)  in  the  .etiology  of  this  affection  which  has  also  been 
called  PSYCHASTHENIA. 

37 


Progressive     Spondylotherapy 

His  conclusions  are  as  follows: 

Cerebrasthenia  is  not  a  rare  disease; 

The  dividing  line  between  it  and  insanity  has  not  been 
clearly  denned; 

Cerebrasthenia  is  the  result  of  vicious  reflexes; 

The  symptoms  of  both  affections  do  not  give  a  clear 
dif  f  erentation ; 

The  true  test  is  that,  if  irritated  peripheral  nerves  can  be 
located,  and  the  reflexes  inhibited,  the  symptoms  disappear; 

To  accomplish  the  latter,  it  is  necessary  to  investigate 
the  condition  of  peripheral  nerves  or  areas  at  the  onset  of 
symptoms; 

The  nature  of  the  disease  is  revealed  by  the  result  of  the 
inhibition  of  peripheral  irritation ; 

Cerebrasthenia  and  splanchnic  congestion  are  often 
associated; 

Splanchnic  congestion  is  in  almost  every  instance,  asso- 
ciated with  exposed  nerve-endings  in  the  rectum; 

These  exposed  nerve-endings  transmit  stimuli  to  the  cells 
in  the  anterior  horns  of  the  spinal  cord  resulting  in 
paralysis  of  the  vasoconstrictors  (splanchnic) ; 

This  paralysis  augments  the  blood  supply  in  the  splanch- 
nic area; 

The  splanchnic  congestion  decreases  intra-abdominal 
pressure ; 

Intra-abdominal  pressure  being  lessened,  a  diminished 
amount  of  blood  is  forced  through  the  portal  vein  and  liver 
to  the  heart; 

The  heart  as  a  consequence  is  unable  to  send  the  normal 
blood-supply  to  the  brain; 

This  condition  causes  cerebral  anemia; 

The  irritated  nerve-endings  in  the  rectum  may  and  often 
do  transmit  reflexes  to  the  vasoconstrictors  of  the  cerebral 

38 


Miscellaneous        Data 

cortex,  which  are  additional  factors  in  the  etiology  of  cerebral 
anemia; 

This  vaso-constriction  of  the  cortex  inhibits  its  function 
and  thus  causes  diminished  cerebration. 

RADICULAR  ROENTGENOTHERAPY. — The  x-rays  are  en- 
dowed with  analgesic  properties  and  this  fact  may  be  utilized 
in  the  treatment  of  neuralgic  affections  by  directing  the  rays 
over  the  segments  corresponding  to  the  radicular  origin  of 
the  implicated  nerves  in  neuralgia  and  neuritis  (371  et  seq.) 

Thus,  in  affections  of  the  BRACHIAL  PLEXUS  the  rays  are 
directed  between  the  spinous  processes  of  the  3rd  cervical 
and  ist  dorsal  vertebrae  (emerging  points)  and  a  little  higher 
for  the  segmental  origin  (20). 

SCIATICA;  4th,  5th  lumbar  vertebrae  and  ist,  2nd  and 
3rd  sacral  (emerging  points). 

TRIGEMINAL  NEURALGIA;   at   the   Gasserian   ganglion 

(374). 

No  effect  can  be  achieved  if  the  site  of  the  lesion  is 
peripheral  to  the  segmental  origin  or  sites  of  exit.  One  must 
exercise  care  in  the  exposures  by  this  method  of  radiotherapy 
which  is  marvelously  efficient  in  neuritic  and  neuralgic  affec- 
tions which  have  resisted  all  other  methods  of  treatment. 

URTICARIA  and  MIGRAINE. — Dr.  Myer  Solis-Cohen 
(Philadelphia),  refers  to  the  instantaneous  relief  secured  by 
concussion  of  the  7th  cervical  spine  in  a  severe  case  of 
urticaria  following  the  use  of  diphtheria  antitoxin.  Itching 
and  rash  quickly  evanesced. 

The  same  method  of  treatment  was  successfully  employed 
by  him  in  a  rebellious  case  of  MIGRAINE  (280). 

PIGMENTATION  OF  THE  SKIN. — Cutaneous  pigmentation 
associated  with  neuralgic  affections  may  be  regarded  as  a 
tropho-neurosis.  Drs.  Jarvis  and  Boslough  (Ashland,  Ore- 
gon), observed  such  an  instance  (Fig.  3)  of  pigmentation  in  a 

39 


Progressive     Spondylotherapy 

patient  with  adhesive  mediastinitis  who  was  relieved  of  pain 
with  almost  complete  evanescence  of  pigmentation  by  freez- 
ing over  the  sites  of  vertebral  tenderness  (5th  to  gth  dorsal). 
Dr.  Edward  S.  Smith  (Bridgeport,  Conn.),  reports  a  case 
of  CHLOASMA  of  face,  neck  and  arms  which  "cleared  up  in  a 
wonderful  degree  by  concussion  of  the  4th  and  5th  dorsal 
spines  (which  showed  paravertebral  areas  of  tenderness  be- 
fore treatment)." 


FIG.  3.— Patient  of  Drs.  Jarvis  and  Boslough  with  pigmentation  of  the  skin  in 
whom  evanesence  of  the  pigmentation  was  effected  by  freezing  the  vertebral  areas 
of  tenderness. 

MOVABLE  KIDNEY.— Dr.  D.  V.  Ireland  (Wilmington, 
Ohio),  at  the  convention  of  "The  American  Association  for 
the  Study  of  Spondylotherapy"  (Sept.  30,  1913),  presented  a 
series  of  interesting  cases  and  among  the  number,  the  follow- 
ing one  of  MOVABLE  KIDNEY  is  selected  for  citation  inso- 
much as  it  suggests  a  novel  method  of  treatment  for  this 
affection : 

"Mrs.  B.,  about  50  years  of  age,  of  slender  build  and 
nervous  temperament,  applied  for  treatment,  complain- 

40 


iscellaneous        Data 


ing  of  a  continuous  burning  pain  in  the  epigastrium 
which,  at  times,  nearly  drove  her  to  distraction. 

The  liver  was  fully  double  its  normal  size,  the  bowels 
obstinately  constipated  and  breath  offensive.  Und^r 
elaterium  the  bow: Is  relaxed  and  the  liver  resumed  its 
normal  size.  As  the  liver  receded,  I  found  the  right 
kidney  prolapsed  until  its  lower  border  was  on  a  line 
with  the  crest  of  the  ilium.  While  the  condition  of 
the  liver  was  much  improved,  the  burning  pain,  the 
coated  tongue  and  offensive  breath  continued  as  before. 
At  this  time  a  surgeon  had  recommended  an  immediate 
operation  for  the  mobile  kidney. 

She  came  again  to  consult  me.  I  commenced  con- 
cussion of  the  i2th  dorsal  spine,  giving  her  daily  treat- 
ments and  to  my  surprise  and  delight,  after  the  third 
treatment  I  found  the  kidney  had  ascended  to  its  normal 
position  where  it  has  remained  permanently  fixed  for 
nearly  a  year.  I  gave  her  in  all  forty-six  treatments  in 
order  to  anchor  the  kidney  permanently;  but  what 
pleased  us  most  of  all  was  that  the  burning  pain  in  the 
epigastrium  (which  I  attributed  to  ulceration  of  the 
stomach  at  the  pyloric  orifice)  gradually  passed  away, 
the  tongue  cleared  and  the  bowels  moved  regularly." 

(NOTE: — The  foregoing  observation  is  original  with 
Dr.  Ireland,  and  the  author  disclaims  any  reference  to 
this  subject  in  any  of  his  writings.  Dr.  Ireland  em- 
phasizes the  fact  that  the  i2th  dorsal  spine  has  the  same 
importance  in  relation  to  diseases  below  the  diaphragm 
as  the  7th  cervical  spine  to  diseases  above  it). 

MALARIA. — Attention  has  already  been  directed  to  the 
spleen  reflex  of  contraction  in  the  diagnosis  of  malaria  (355). 

In  Kansas  City,  the  author  recently  examined  Dr.  Boyce, 
in  whom  splenomegaly  was  demonstrated. 

An  examination  of  the  blood  by  Dr.  Purdue  before  and 
after  concussion  to  elicit  the  spleen  reflex  demonstrated  the 
presence  of  plasmodia  in  the  blood  only  after  concussion. 

•Dr.  Boyce  writes  as  follows: 

41 


Progressive     Spondylotherapy 

"Eight  days  after  your  concussion  (Oct.  17,  '13)  almost 
to  the  hour,  the  chill  appeared;  a  regular  old-fashioned  one. 
I  consider  the  case  unique  insomuch  as  it  is  fully  15  years 
since  I  had  a  chill  although  I  had  malarial  symptoms  5  years 
ago  which  yielded  to  quinin." 

PELVIC  LEVEL. — This  (Fig.  4)  was  described  by  Smith 
(Lancet,  Jan.  21,  1911),  and  is  employed  for  comparing  the 
standing  height  of  the  legs  in  cases  of  SCOLIOSIS. 

The  patient  stands  erect,  boots  off  and  hips  exposed. 
A  dot  is  placed  over  each  anterior  superior  iliac  spine  with  a 
dermatographic  pencil,  and  the  pelvic  level  is  applied  so  that 
its  upper  straight  edge  passes  through  both  these  dots. 


FIG.  4. — Pelvic  level  for  comparing  the  standing  height  of  the  legs  in  cases 
of  scoliosis. 


If  the  spirit  level  then  indicates  horizontal,  the  legs  are 
equal  as  regards  standing  height. 

If  it  does  not,  blocks  of  wood  of  known  thickness  are 
placed  beneath  the  foot  on  the  shorter  side  until  the  hori- 
zontal is  reached — the  sum  of  the  blocks  used  gives  the  dif- 
ference between  the  two  legs. 

This  method  is  very  simple  and  very  exact,  and  presumes 
only  that  the  pelvis  is  symmetrical  as  regards  the  height  of 
the  anterior  spines  above  the  acetabula. 

PROPSUS  UTERI. — The  following  report  concerns  a 
patient  with  this  affection: 

"The  occasion  of  my  addressing  you  pertains  to  the 
value  of  the  uterus  reflex  (zoo).  The  patient  in  question  has 
suffered  for  many  years  from  prolapsus  uteri  which,  having 

42 


Miscellaneous        Data 

resisted  conventional  treatment,  she  had  made  preparations 
to  go  to  Denver  for  an  operation.  After  the  second  seance 
of  concussion,  the  uterus  was  raised  to  within  one  inch  of  its 
normal  position  and  after  the  third  seance  it  regained  the 
norm  and  has  remained  there  ever  since." 

Dr.  D.  V.  Ireland,  regards  sinusoidalization  of  the  i2th 
dorsal  spine  of  greater  efficiency  for  prolapsus  uteri  than  the 
2nd  lumbar  spine  (358). 

The  author,  from  further  observation,  justifies  Dr.  Ire- 
land in  his  contention  and  observes  furthermore  that  sinu- 
soidalization of  the  2nd  lumbar  spine  is  the  site  of  choice  to 
secure  dilatation  of  the  cervix  uteri. 

PAINLESS  LABOR. — Several  physicians  engaged  in  obstet- 
rical practice  have  informed  me  that  during  labor  one  may 
demonstrate  paravertebral  points  of  tenderness  correspond- 
ing to  the  lumbar  vertebrae  and  that  pressure  (170)  at  these 
areas  will  in  most  instances  either  mitigate  or  arrest  pains 
and  thus  contribute  to  painless  labor. 


HUMAN  ENERGY 


CONTENTS 

Page 

latro-Physical  and  Chemical  Schools  -     49 

The  Modern  Knowledge    -  49 

Human  Energy  -     53 

Energeiagenic  Centers       -  60 

Energy-Discharge  Without  Conductors       -  -     64 

Sympathetic  Irritation      -  64 

Photographic  Action    -  -     70 

Sexual  Polarity       -  72 

Diagnosis  of  Sex  of  the  Fetus  -     78 

Determination  of  Sex  81 

New  Concepts  in  Diagnosis    -  -     82 

Neoplasms   -  84 

Normal  and  Pathological  Energy      -  -     89 

Syphilis  90 

Dementia  Paralytica    -  -     91 

Tuberculosis  -          94 

Electronic  Reactions  (Table)  -  -  -  96 
Epilepsy  -  ....  IOo 
Diagnosis  of  Death  -------  100 


INTRODUCTION 

The  author's  new  physico-diagnostic  methods  are  not  theories 
but  physico-clinical  facts.  They  have  been  repeatedly  corroborated 
by  necropsy,  skiagraphy,  at  operations  and  by  histological  examina- 
tions. The  laws  of  physical  science  are  universal  and  apply  equally 
to  living  organisms  and  so-called  inanimate  things. 

This  iatrophysical  conception  demonstrates  the  trend  of  unifying 
the  various  forms  of  force  under  one  great  principle. 

The  electronic  theory  demonstrates  the  electrical  nature  of  matter. 

Radio-activity  is  a  universal  property  of  matter. 

In  disease,  the  rearrangement  of  the  electrons  is  associated  with 
the  evolution  of  energy  which  is  either  neutral  or  endowed  with  a 
definite  polarity. 

The  author's  stomach  reflex  is  employed  as  a  delicate  physiological 
test  for  the  presence  of  this  energy. 

PERCUSSION  OF  THE  LOWER  STOMACH-BORDER. 

A  correct  interpretation  of  physico-diagnosis  predicates  an  under- 
standing of  the  author's  method  of  delimiting  the  lower  border  of  the 
stomach  in  apposition  with  the  abdominal  parietes  and  this  is  only 
possible  with  the  subject  in  the  erect  posture. 

The  principle  involved  in  the  elicitation  of  the  stomach  reflex  of 
Abrams  is  as  follows: 

In  the  norm,  a  tympanitic  sound  is  elicited  but  if  the  tone  of  the 
gastric  musculature  is  augmented  the  walls  of  the  organ  become 
tense,  thus  putting  the  air  or  gas  in  the  stomach  under  increased  ten- 
sion. For  the  latter  reason,  we  have  the  physical  elements  necessary 
for  the  transition  of  a  tympanitic  to  a  dull  sound. 

Until  a  better  acquaintance  with  this  method  is  attained,  a  healthy 
subject  must  be  selected  with  moderately  thin  abdominal  walls  and 
in  whom  a  tympanitic  sound  is  demonstrable  by  percussion  over  the 
entire  abdomen. 

The  stomach  shows  a  varying  state  of  tonicity;  it  may  be  normal 
(orthotonic),  increased  (hypertonic),  diminished  (hypotonic)  or  absent 
(atonic). 

47 


n      t      r      o      d      u 


o      n 


For  the  foregoing  reason,  in  executing  the  electronic  reactions  an 
individual  with  known  stomach-tonicity  may  be  employed  as  a  test- 
subject.  In  the  latter  instance,  the  energy  is  conveyed  from  the 
patient  by  means  of  an  insulated  copper-cord  to  the  stomach-region 
of  the  subject. 

For  esthetic  reasons,  the  subject  may  be  screened  from  the  patient. 

The  subject  must  stand  on  a  flooring  of  unvarnished  wood.  Car- 
pet interposed  between  the  latter  and  the  feet  of  the  subject  is  not 
objectionable. 

To  increase  the  tone  of  the  gastric  musculature  sufficient  to  elicit 
dulness,  two  simple  maneuvers  are  available: 

1.  While  the  patient  or  an  assistant  directs  either  pole  of  a  bar- 
magnet  at  a  distance  of  about  4  inches  from  the  presumable  location 
of  the  lower  stomach-border,  light  percussion  is  executed  from  below 
upward  until  dulness  is  elicited;  this  is  the  lower  border  of  the  stomach 
and  its  position  should  be  marked  with  a  dermograph. 

2.  During  the  time  energy  is  conveyed  from  the  heart-region  of 
the  subject  to  the  stomach-region  by  means  of  an  insulated  cord  of 
copper  as  shown  in  Fig.  7,  execute  percussion  after  the  manner  cited 
in  the  first  maneuver. 

Finger-finger  is  preferable  to  instrumental  percussion  but  those 
unskilled  in  the  former  may  avail  themselves  of  the  plexor  and  plexi- 
meter  as  shown  in  Fig.  6,  which  have  been  specially  devised  by  the 
author  to  substitute  maladroit  percussion. 

The  lower  border  of  the  stomach  having  once  been  determined,  one 
may  proceed  with  the  electronic  test.  The  stomach  reflex  is  easily 
exhausted  and  one  must  ascertain  in  the  course  of  the  examination 
if  it  is  still  present  by  conveying  energy  from  the  heart  or  by  the  use 
of  the  bar-magnet. 

ALBERT  ABRAMS. 
291  GEARY  STREET, 
SAN  FRANCISCO,  CAL., 
JANUARY,  1914. 


48 


HUMAN     ENERGY* 


IATRO-PHYSICAL  AND   IATRO-CHEMICAL    PERIODS 
OF  MEDICINE. 

At  one  time  in  the  history  of  medicine,  the  period  of 
medical  mysticism,  physics  and  chemistry  were  invoked  to 
explain  the  actions  and  functions  of  the  body  and  to  recon- 
cile the  dogmas  of  physics  and  chemistry  with  empirical 
methods  in  the  treatment  of  disease. 

The  iatro-physiochemical  doctrines  endowed  with  ex- 
clusivism  failed  to  survive  the  lapse  of  time. 

Recent  researches  which  I  have  made  bearing  on  the 
question  of  human  energy  seem  to  emphasize  the  importance 
of  the  laws  of  physical  science  in  the  investigation  of  disease 
and  the  physician  is  constrained  to  correlate  his  data  with 
this  new  knowledge. 

THE   MODERN  KNOWLEDGE. 

The  forces  found  in  the  living  body  correspond  with 
those  which  govern  the  inanimate  world  and  the  theory  of 


*Abstract  of  an  address  by  Dr.  Albert  Abrams,  of  San  Francisco,  before  "The 
American  Association  for  the  Study  of  Spondylotherapy,"  at  its  meeting  in 
Chicago,  Sept.  30,  1913,  and  repeated  with  demonstrations  before  the  "Chicago 
Hospital  College  of  Medicine,"  Thursday  evening,  Oct.  2,  1913,  to  the  medical 
profession  of  Chicago. 

A  special  work  dealing  more  specifically  with  this  subject  will  be  published  by  the 
author  early  in  the  year  1914.  Numbers  in  parentheses  (not  italicized)  refer  to 
the  pages  in  SPONDYLOTHERAPY  where  the  subject  has  already  been  discussed. 
When  the  numbers  in  parentheses  are  italicized,  they  refer  to  the  pages  in  Progressive 
Spondylotherapy,  1913. 

49 


Progressive     Spondylvtherapy 

vitalism  (178)  has  been  abandoned.  Physical  science  by 
reason  of  the  universality  of  its  laws  dominates  practically 
every  phase  of  medical  research. 

The  circulation  of  the  blood  is  a  matter  of  hydraulics; 
the  changes  of  gases  in  the  lungs  and  tissues  correspond  to 
the  physical  theory  of  gases  and  heat-regulation  conforms  to 
the  physical  theory  of  heat. 

Aseptic  surgery  and  anesthesia  are  chemical  contribu- 
tions to  our  storehouse  of  medical  knowledge.  The  "Cell 
Theory"  and  "Cellular  Pathology,"  embodied  the  conception 
that  the  activities  of  an  organism  are  the  sum  of  the  activ- 
ities of  its  component  cells  which  were  regarded  as  the  most 
elementary  form  of  organized  substances  incapable  of 
further  reduction  other  than  by  mechanic  or  chemic  means. 

"Cellular  Pathology,"  does  not  emphasize  in  accordance 
with  the  "Electronic  Theory"  (115)  the  ultimate  atomic 
divisibility  of  matter  and  I  shall  later  exploit  this  theory  to 
suggest  the  inauguration  of  a  new  diagnosis  and  pathology 
which  I  shall  respectively  neologize  as  "Electron  Diagnosis" 
and  "Electron  Pathology." 

The  time  is  fast  approaching  when  the  activities  of  living 
cells  will  find  explanation  on  a  physico-chemical  basis  and 
when  the  biologist  shall  know  the  laws  that  govern  cell- 
growth  with  the  accuracy  of  the  scientist  knowing  his  laws. 
It  will  be  then  that  prevention  and  cure  will  be  questions  of 
scientific  accuracy.  As  physicians  we  dare  not  stand  aloof 
from  the  progress  made  in  science  and  segregate  the  human 
as  something  apart  from  the  other  entities  of  the  physical 
universe.  Our  differentiation  of  matter  is  largely  morpho- 
logic. Whether  the  object  of  our  differentiation  is  a  human 
or  a  germ,  we  are  only  dealing  with  a  congregation  of  vibrat- 
ing atoms  which  in  their  varied  combinations  are  the  basic 
constituents  of  all  that  exists. 

50 


The        Modern        Knowledge 

There  are  three  physical  entities: 

1.  Matter, 

2.  Energy, 

3.  Ether. 

The  electron  or  corpuscular  theory  which  most  fully  accords 
with  modern  investigations  concerning  the  physical  basis  of 
the  material  universe  conceives  matter  to  be  made  up  of 
molecules;  molecules  to  be  composed  of  atoms  and  atoms  to 
consist  of  electrons  (116).  The  electrons  or  corpuscles  are 
charges  of  electricity.  The  atoms  of  matter  are  individ- 
ualized masses  of  positive  electricity  diffused  uniformly  over 
the  area  of  an  atom,  spherical  in  shape  and  one  two-hundreth 
millionth  of  an  inch  in  diameter. 

Throughout  the  spherical  mass  are  some  eight  hundred 
minute  particles  of  negative  electricity  all  alike  flying  vigor- 
ously about,  each  repelling  every  other  particle  yet  all  con- 
tained within  their  orbits  by  the  mass  of  positive  electricity 
which  constitutes  only  about  one  per  cent,  of  the  atom's  mass. 

The  number  of  electrons  in  an  atom  are  proportional  to 
the  atomic  weight  of  the  element.  When  the  crowding  of  the 
electrons  becomes  excessive  as  in  radium,  thorium  or  uran- 
ium, the  atoms  become  radioactive  owing  to  collisions 
between  the  electrons,  some  of  which  are  constantly  shot 
away  (116).  Radiation  refers  to  a  change  in  the  velocity  of 
an  electron  which  causes  ripples  in  the  surrounding  ether. 
Whenever  the  velocity  of  an  electric  charge  is  increased, 
diminished  or  changed  in  direction,  Roentgen  rays,  light  and 
all  other  radiations  result. 

As  I  shall  show  you,  practically  all  atoms  of  matter  are 
radioactive,  assuming  that  the  streams  of  radiations  also 
consist  of  ethereal  vibrations  as  well  as  flying  particles. 

The  following  data  may  be  summarized  concerning 
electrons: 

51 


Progressive     Spondylotherapy 

1.  The  electron  is  the  smallest  entity  known  to  science 
and  is  a  thousand  times  smaller  in  mass  than  the  smallest 
atom. 

2.  It  is  a  sphere  of  positive  electrification  enclosing  a 
number  of  negatively  electrified  corpuscles  which  counter- 
balance the  positive  electricity  of  the  enclosing  sphere. 

3.  The  electrons  are  characterized  by  the  uniformity  of 
their  vibrations.    This  is  demonstrated  by  the  sharpness  of 
the  lines  of  light  making  up  the  spectrum  of  an  element. 
These  lines  originate  from  the  vibrations  of  electrically 
charged  systems  and  if  the  vibrations  of  different  atoms 
were  not  attuned  to  each  other,  the  spectral  lines  would  be 
blurred  and  diffused. 

4.  Light  and  other  radiations  are  dependent  on  dis- 
turbances in  the  surrounding  ether  (209)  caused  by  a  change 
in  the  motion  of  the  corpuscles. 

We  refer  to  perpetual  motion  as  impossible,  yet  the  whole 
universe  is  nought  else.  Matter  is  only  an  effect  of  a  definite 
kind  of  motion. 

During  the  revolutions  of  the  electrons,  thousands  of 
millions  of  times  per  second,  an  electro-magnetic  field  of 
energy  is  created  but  the  rhythmic  changes  in  the  field  of 
energy  thus  transmitted  by  the  ether  have  thus  far  eluded 
all  instruments  for  their  detection  and  study. 

Everything  in  nature  is  in  a  state  of  perpetual  motion 
and  the  latter  is  continually  changing  from  one  velocity  to- 
another. 

The  power  to  change  the  state  of  motion  of  a  body  is 
ENERGY.  The  total  energy  contained  in  matter  depends 
on  the  extent  to  which  it  can  be  changed.  Energy  is  the 
universal  commodity  on  which  all  life  depends. 

All  forms  of  energy  whether  derived  from  heat,  electricity, 
magnetism  or  gravitation  are  interconvertible  and  represent 

52 


Human         Energy 

practically  different  varieties  of  motion.  Energy,  like  matter 
can  neither  be  created  nor  destroyed. 

The  energy  in  all  matter  is  enormous  and  it  has  been 
estimated  that  one  gram  of  hydrogen  possesses  sufficient 
energy  to  raise  one  million  tons  through  a  height  exceeding 
three  hundred  feet. 

Electrons  are  only  electricity  and  nought  else  is  in  exis- 
tence but  electrons. 

In  gases,  electricity  is  conducted  by  free  corpuscles  flying 
bullet-like  and  with  velocities  often  approximating  100,000 
miles  per  second.  In  liquids,  the  conduction  is  only  about 
an  inch  an  hour. 

In  metallic  conduction,  the  atoms  are  relatively  fixed  and 
their  only  power  is  that  of  vibration.  Certain  corpuscular 
aggregations  will  hold  in  an  unstable  condition  a  few  more 
corpuscles  than  exactly  suffices  to  balance  the  surrounding 
sphere  of  positive  electricity.  The  atom  thus  constituted 
is  negatively  charged.  Others  hold  a  few  less  corpuscles  than 
suffices  to  balance  the  positive  electricity.  This  leaves  the 
atom  Dositively  electrified. 

If  these  two  types  of  atoms  are  free  to  move  and  they 
unite  and  neutralize  each  electrically,  we  have  chemical 
union. 

HUMAN  ENERGY. 

The  present  age  marvels  at  man's  conquests  of  the  forces 
of  nature.  Yet,  this  age  of  energy  can  only  be  triumphant 
when  man  can  know  and  then  direct  and  control  the  more 
important  forces  within  himself. 

Epoch-making  discoveries  in  science  usually  date  from, 
the  discovery  of  a  sensitive  mechanism  which  reveals  some 
phenomenon  of  the  atomic  world. 

The  radium  emanation  has  been  detected  by  the  elec- 
troscope. 

53 


Progressive     Spondylotherapy 

The  latter  is  a  million  times  more  sensitive  than  a  spec- 
troscope yet  the  latter  will  detect  the  millionth  of  a  milli- 
gram of  matter.  The  delicacy  of  Einthoven's  string-galvan- 
ometer has  established  the  principles  of  electro-cardiography. 

The  physiologic  mechanism  which  I  employ  for  detecting 
human  energy  is  the  living  stomach  and  which  may  be 
designated  as  "gastrometer." 

It  is  essentially  a  stomach  reflex  which  I  have  discussed 
at  length  (316,  321,  584,  123,  145,  146,  147,  153,  163}.  In 
accepting  the  reaction  of  the  stomach-musculature  as  the 
basis  for  our  varied  deductions,  we  are  employing  bioplasmic 
matter,  the  most  primitive  and  sensitive  substance  for 
exhibiting  the  phenomenon  of  vitality.  The  pupillary 
response  to  light  is  an  energy-contraction  not  unlike  that 
under  consideration.  A  frog's  muscle  is  now  used  for  record- 
ing wireless  messages  (148) . 

I  have  referred  to  the  sensitiveness  of  the  electroscope. 
The  latter  is  less  sensitive  than  the  stomach  reflex.  The 
stomach  reflex  will  detect  the  rays  emanating  from  radium 
at  a  greater  distance  than  will  the  electroscope. 

Modifications  in  the  tone  of  the  stomach  when  the  region 
of  the  latter  is  exposed  to  the  various  forms  of  energy  are 
demonstrated  by  percussion  and  tracings  (167,  169,  170}. 

Percussion,  however,  is  more  easily  executed.  Much 
difficulty  will  be  encountered  at  first  in  eliciting  the  dulness 
of  the  stomach. 

It  must  be  recalled  that  the  stomach  is  immersed  in  an 
atmosphere  of  tympany,  therefore  the  percussion-blow  must 
be  localized,  otherwise  the  vibration  of  surrounding  tissues 
will  mask  the  dull  or  tympanitically  dull  area  of  the  lower 
border  of  the  stomach. 

The  best  results  are  secured  by  finger-finger  percussion; 

54 


H 


u      m      a      n 


E 


n 


g 


one  finger  acting  as  a  pleximeter  and  the  other  finger  as  a 
plexor. 

After  this  manner  one  can  appreciate  the  resistance  of 
tissues  percussed  (palpable  percussion). 

To  localize  the  percussion-blow,  the  second  finger  (usually 
employed)  acting  as  a  pleximeter  must  be  held  rigid  with  the 
ungual  phalanx  slightly  raised  (Fig.  i). 


FIG.  1. — The  upper  figure  represents  the  correct  position  of  the  finger  when 
used  as  a  pleximeter.  The  cross  indicates  the  part  of  the  digit  to  be  struck  by  the 
other  finger  acting  as  a  plexor.  The  lower  figure  indicates  the  incorrect  position 
of  the  finger  in  eliciting  dulness  of  the  stomach. 

If  the  latter  precaution  is  not  taken  and  the  terminal 
phalanx  rests  on  the  abdomen,  the  blow  will  be  transmitted 
to  the  contiguous  area  and  the  tympanitic  tone  elicited  will 
obscure  the  stomach-dulness. 

When  difficulty  is  encountered  by  the  method  of  percus- 
sion indicated,  one  may  employ  the  method  already  shown 
(511)  or  one  may  use  an  ordinary  glass  rod  which  is  held  at 

55 


Progressive      Spondylotherapy 

the  same  angle  as  the  finger  and  then  percussed.  For 
those  unskilled  in  finger-finger  percussion,  the  plexor  and 
pleximeter  shown  in  Fig.  2  have  been  devised  by  the  author. 
Light  blows  with  the  plexor  yield  the  best  results — a  sound 
almost  woody  in  character  when  the  lower  border  of  the 
stomach  is  attained. 


FIG.  2. — Plexor  and  pleximeter  for  the  use  of  physicians  unskilled  in  finger- 
finger  persussion.  The  dark  area  in  the  pleximeter  represents  a  small  quantity  of 
wax.  The  latter  eliminates  all  adventitious  sounds  likely  to  disturb  the  elicitation 
of  stomach-dulness.  A  light  blow  yields  the  best  results  and  when  the  lower  border 
of  the  stomach  is  attained,  an  unmistakable  woody  sound  is  audible. 

It  is  best  to  first  define  the  lower  border  of  the  liver 
(Fig.  3) ;  next  define  the  lower  border  of  the  stomach  by  aid 
of  the  conducting  cord.  Observe  that  when  energy  is  con- 
ducted from  the  heart  to  the  epigastric  region  the  liver- 
border  may  be  found  lower  for  reasons  cited  (150). 

After  the  conveyance  of  an  excess  of  energy  which  occurs 
in  disease,  the  lower  border  of  the  stomach  is  retracted  (Fig.  3). 

The  dulness  of  the  stomach  may  be  accentuated  by  hav- 
ing the  patient  firmly  fix  with  his  hand  the  lumbar  spines 
to  suppress  their  vibration  (80). 

56 


H 


u 


m 


a 


n 


E 


n 


r     g    y 


The  stomach  reflex  (gastrometer)  is  exceedingly  sensitive 
although  the  latter  varies  with  the  tone  of  the  organism. 
When  its  tone  is  impaired  and  its  sensitiveness  is  in  conse- 
quence diminished,  I  convey  the  energy  from  the  individual 
examined  to  the  stomach-region  of  another  individual,  with 
a  stomach-tone  of  known  sensitiveness.  When  the  stomach 
fails  to  respond  promptly  to  the  action  of  energy,  it  may  be 
made  more  sensitive  by  definite  maneuvers  which  I  shall 
demonstrate  later. 


Fie.  3. — Illustrating  method  of  conveying  energy  from  the  heart  to  the 
stomach-region. 

Continuous  line,  lower  border  of  stomach;  dotted  line,  retracted  stomach- 
border;  broken  line,  lower  liver-border. 

I  have  specified  the  energy  of  the  human  organism  as 
anthropodynamic  because  it  is  a  specific  electronic  energy. 
A  nerve-impulse  resulting  from  the  action  of  a  stimulus  lib- 
erates energy  stored  within  protoplasm.  Heretofore,  the 
only  evidence  of  the  liberation  of  energy  was  the  electrical 
change;  the  wave  of  negativity.  This  energy  was  supposed 

57 


Progressive     Spondylotherapy 

to  be  electrical  but  this  is  disproved  by  the  measurement 
of  its  velocity. 

Atomic  differentiation  as  I  conceive  it,  is  only  a  question 
of  vibration-frequencies  and  each  atom  is  endowed  with  a 
specific  rate  of  vibration.  Colors  are  the  effect  of  particu- 
lar frequencies  of  vibration. 

The  stomach  does  not  respond  (as  revealed  by  dulness) 
to  all  degrees  of  vibration  (206} .  I  set  in  action  at  some  dis- 
tance from  this  patient  a  tuning-fork  with  a  vibration- 
number  of  256.  Note  that  dulness  of  the  stomach  at  once 
ensues,  but  observe  that  the  dulness  is  at  once  dissipated 
when  the  negative  pole  of  a  bar-magnet  is  held  in  proximity 
to  the  stomach,  whereas  the  positive  pole  presented  to  the 
organ  maintains  the  dutness.  In  consequence  of  the  fore- 
going we  must  conclude  that  the  vibrations  are  positive. 

The  nerves  of  taste  and  smell  must  be  endowed  with 
specific  electrons  which  are  only  attuned  to  different  vibra- 
tion-rates hence  the  differentiation  of  taste  and  smell  like 
the  differentiation  of  color  (203). 

The  energy  evolved  from  the  human  is  as  characteristic 
of  the  human  as  the  energy  evolved  from  the  lower  animals 
is  distinctive  for  the  lower  animals. 

Furthermore,  one  man  differs  from  another  man  only  in 
the  sense  that  his  electrons  show  varying  rates  of  vibration. 
The  diamond,  lampblack  and  charcoal  are  all  practically 
identical  in  composition.  Oil  of  roses  and  coal  gas  have  the 
identical  composition  (4  atoms  of  hydrogen  and  4  atoms  of 
carbon),  yet  the  mephitic  odor  of  the  one  and  the  delightful 
odor  of  the  other  is  merely  a  question  of  rate- vibration. 

Now  the  attunement  of  the  organism  shows  a  physio- 
logic rhythmicity  at  different  periods  of  the  day  and  further- 
more this  attunement  is  modified  by  disease  and  tempera- 

58 


Human        Energy 

ment.    These  facts  have  been  established  by  tests  made  with 
Galton's  whistle  (Fig.  4). 

You  will  observe  that  by  modifying  the  tone  of  my  voice, 
I  can  elicit  varying  nuances  of  stomach-dulness.  The  re- 
sponse of  the  stomach  is  so  sensitive  that  it  faithfully 
records  the  dots  and  dashes  from  an  ordinary  transmitter 
operated  at  a  considerable  distance  from  the  subject  (Fig.  5). 
The  gastrograph  (167}  was  employed  for  making  the  records. 


FIG.  4. — Gallon  whistle.  This  consists  of  a  steel  tube  in  which  air  is  caused  to 
vibrate.  The  note  produced  by  it  becomes  higher  as  its  length  is  diminished  and 
ranges  from  6,481  vibrations  per  second  to  the  highest  perceptible  tone-limit. 

In  atomic  differentiation  we  must  also  take  into  consider- 
ation the  POLARITY  of  ENERGY.  The  oils  of  orange  and 
cloves  have  the  same  chemical  composition — 16  atoms  of 
hydrogen  and  16  of  carbon — yet  each  has  its  specific  odor 
and  taste.  I  now  expose  the  oil  of  orange  to  the  abdomen 
approximating  the  stomach  and  you  note  no  change  in  the 
percussion-sound  of  the  latter. 

However,  if  I  carry  out  the  same  maneuver  with  oil  of 
cloves,  the  tympanitic  sound  of  the  stomach  is  at  once  con- 

59 


Progressive     Spondylotherapy 

verted  into  dulness  and  furthermore  the  dulness  is  main- 
tained by  the  positive  pole  of  a  bar-magnet  and  is  dissipated 
by  the  negative  pole,  hence  the  polarity  of  the  energy  is 
positive.* 


FIG.  5. — Dots  and  dashes  from  a  transmitter  recorded  by  the  contractions  ot 
the  human  stomach. 


ENERGEIAGENIC   CENTERS. 

There  are  definite  areas  of  the  body  which  are  constantly 
discharging  energy  and  the  energy  thus  discharged  differs 
in  polarity  in  the  two  sexes. 

Fig.  6  represents  the  centers  of  energy  in  a  male  and 
Fig.  7  illustrates  the  centers  in  the  opposite  sex. 

Both  figures  are  marked  by-f-   (positive),  — (negative) 


*Opposite  poles  of  bar-magnets  directed  toward  t.ie  stomach  dissipate  the  dulnes 
of  the  latter  whereas  like  poles  multiply  the  intensity  of  the  dulness  (/5J,  ij-,') 


Energeiagenic      C  e   n    t  e   r  s 


and  O  (neutral)  signs,  indicating  the  polarity  of  the  energy 
emanating  from  different  regions  of  the  body. 

The  discharge  of  energy  with  reference  to  the  extremities 
only  occurs  at  the  tips  of  the  fingers  and  toes. 


J-AU  AKTtRIES 


POSITIVE 
ENC.K6V 


NEGATIVE  __ 


POSITIVE 


FIG.  6. — Normal  energeiagenic  centers       FIG.  7. — Normal  energeiagehic  centers 
in  a  male.  in  a  female. 

Common  to  both  sexes  in  the  norm  there  is: 

1.  A  positive  (+)  discharge  from  the  arteries. 

2.  A  negative  ( — )  discharge  from  the  veins. 

3.  A  neutral  (O)  discharge  from  the  7th  cervical  spine 
and  positive  discharge  from  the  ist  lumbar  spine. 

61 


Progressive     Spondylotherapy 

4.  A  negative  discharge  from  the  regions  occupied  by 
the  kidneys. 

The  epigastric  area  discharging  neutral  energy  is  limited 
to  the  central  line  of  the  abdomen  and  extends  upwards  to  a 
distance  of  about  5  cm.  above  the  navel. 


FIG.  8. — Normal  energeiagenic  center?  in  the  back  common  to  both  sexes. 

From  any  of  the  foregoing  centers  one  may  conduct  the 
energy  by  means  of  an  ordinary  flexible  insulated  cord 
(approximately  80  cm.  in  length)  of  copper,  or  aluminum 
wire. 

Insulated  aluminum  wire  is  the  most  effective  material 
for  conducting  human  energy. 

The  metal  tips  of  the  conducting  wire  in  contact  with  the 
fingers  must  be  insulated.  Placing  one  tip  of  the  cord 
(which  must  not  be  insulated)  to  any  center  of  energy  and 
the  other  tip  in  contact  with  the  stomach-region  or  several 

62 


Rnergeiagenic      C  e   n   t  e   r  s 

inches  away  (if  the  energy  conveyed  is  of  sufficient  potency), 
an  immediate  dulness  of  the  stomach  is  elicited  and  by  aid 
of  the  bar-magnet  one  may  determine  the  polarity  of  the 
energy  during  the  flow  of  the  latter. 

It  is  wise  to  first  determine  the  lower  border  of  the 
stomach  by  aid  of  the  energy  from  the  heart.  This  is  done 
by  fixing  one  end  of  the  conducting  wire  to  the  heart-region 
and  the  other  end  to  the  region  of  the  stomach*  (Fig.  3). 

In  a  male  and  female  subject,  dulness  of  the  stomach  is 
evoked  from  all  areas  of  energy  shown  in  Figs.  6,  7,  and  8. 

I  wish  to  direct  your  attention  to  a  new  OCULO- 
GASTRIC  REFLEX  which  likewise  differs  in  the  sexes. 
Looking  through  a  red  medium,  stomach-dulness  in  the 
male  is  only  elicited  when  the  right  eye  is  thus  employed, 
whereas  in  the  female  gazing  through  red  with  the  left 
eye  produces  dulness. 

The  influence  of  color  on  the  tonicity  of  the  organs 
has  been  discussed  (199,  200). 

One  may  measure  the  intensity  of  conveyed-energy  by: 

1.  The  intensity  of  stomach-dulness. 

2.  The  distance  which  the  tip  of  the  cord  approximating 
the  stomach-region  will  produce  dulness  (i.  e.,  whether  the 
tip  must  be  in  immediate  contact  with  the  abdomen  or  sev- 
eral inches  away). 

3.  The  duration  of  dulness. 

4.  The  degree  of  stomach-retraction. 

The  last  method  of  estimation  is  the  most  convenient  and 
reliable.  Thus,  one  may  gauge  the  energy  of  the  heart,  the 
testicles,  ovaries,  etc.  (166,  188} . 


*By  interposing  an  insulating  material  between  the  floor  and  the  feet,  the  trans- 
mitted energy  is  incapable  of  eliciting  the  stomach  or  any  other  visceral 
reflex. 
In  other  words,  the  individual  must  be  grounded  (earth-connection). 

63 


H 


u 


m 


a 


n 


E 


n 


g 


Another  index  of  energy  is  the  degree  of  descent  of  the 
lower  border  of  the  lung  (472)  by  conveying  the  energy  to 
the  yth  cervical  spine. 

The  physician  reasonably  skilled  in  percussion  may 
utilize  the  heart  or  the  lower  border  of  the  liver  as  indices  of 
conveyed  energy  (150,  184}. 

In  this  patient,  by  conducting  the  energy  from  his  epigas- 
trium to  his  7th  cervical  spine  by  aid  of  insulated  aluminum 
wire,  his  pulse  can  be  inhibited. 


FIG.  9. — Calbrated  tube  of  glass  with  connecting  cord  for  measuring  the 
intensity  of  energy-discharge. 

Another  method,  not  mentioned,  for  measuring  the  in- 
tensity of  energy  is  based  on  the  principle  that  the  further 
away  the  tip  of  the  end  of  the  conducting  cord  is  from  the 
source  of  energy  eliciting  stomach-dulness,  the  greater  is  the 
energy-discharge.  For  this  purpose  I  employ  a  calibrated 
glass-tube  (Fig.  9)  through  which  the  wire  passes  and  which 
is  gradually  withdrawn  until  the  energy-discharge  is  no  longer 
able  to  produce  stomach-dulness.  Thus  in  the  average  male, 
dulness  of  the  stomach  from  energy  derived  from  the  left 

64 


Sympathetic       Irritation 

psychomotor  region  is  rarely  elicited  if  the  end  of  the  con- 
ducting cord  is  further  distant  than  one-quarter  inch  from  the 
region  in  question. 

SYMPATHETIC  IRRITATION. 

The  epoch-making  work  achieved  by  Dr.  E.  H.  Pratt, 
with  relation  to  the  orificial  reflexes  prompted  me  to  devise 
some  diagnostic  method  whereby  one  could  recognize 
sympathetic  irritation,  provoked  by  some  anomaly  of  the 
orifices  (rectum,  urethra) .  In  the  norm,  there  is  a  discharge 
of  energy  from  the  yth  cervical  and  ist  lumbar  spines. 
From  the  former  situation  the  area  discharging  energy  ex- 
tends on  either  side  a  distance  of  3  cm.  from  the  spinous 
process;  in  the  latter  situation  (ist  lumbar  spine),  it  extends 
a  distance  of  2cm.  from  the  spinous  process  on  either  side. 

In  sympathetic  irritation  from  orificial  or  other  lesions 
implicating  the  sympathetic,  a  discharge  of  neutral  energy 
may  be  obtained  in  the  entire  region  of  the  dorsal  vertebrae 
at  a  distance  of  5.6  cm.  on  both  sides  from  the  spinous  pro- 
cesses. In  other  words,  no  energy-discharge  is  elicited  until 
the  end  of  the  wire  attains  a  point  5.6  cm.  distant  from  the 
spinous  processes  and  this  discharge  is  obtainable  equidis- 
tant from  the  latter  throughout  the  dorsal  region. 

DISCHARGE   OF  ENERGY  WITHOUT  CONDUCTORS. 

There  are  many  individuals  notably  temperamental  ones, 
whose  mere  presence  will  evoke  the  stomach  reflex. 

Let  such  a  one,  if  a  male,  point  his  left  finger  at  the  region 
of  the  stomach  of  the  subject  and  the  stomach  will  imme- 
diately dull.  A  temperamental  female  will  achieve  the  same 
object  with  her  extended  right  finger. 

Let  either  one  touch  the  yth  cervical  spine  (228,  469) 
with  either  finger  and  after  the  lapse  of  several  seconds  there 

65 


Progressive     Spondylotherapy 

is  decided  retardation  of  the  pulse  of  the  subject  which  in 
some  instances  amounts  to  temporary  inhibition. 

In  executing  this  experiment  a  subject  with  a  feeble  pulse 
should  be  selected. 

The  results  of  such  an  experiment  are  best  determined  by 
sphygmography  (Fig.  10). 

I  have  already  discussed  psychic  energy  (ipo). 


FIG.  10.  —  Illustrating  the  effect  on  the  pulse  before  and  during  the  time  an 
index  finger  is  placed  at  the  7th  cervical  spine. 

The  transmission  of  thought  is  only  possible  when  one 
side  of  the  brain  is  put  out  of  commission.  Several  man- 
euvers have  been  suggested  for  this  purpose  (zpo,  192),  but 
the  latest  and  simplest  maneuver  is  to  place  the  fingers  of  the 
left  hand  on  the  left  psychomotor  region  or  the  fingers  of  the 
right  hand  on  the  right  psychomotor  region. 

Individuals  who  show  no  spontaneous  discharge  of  energy 
may  be  made  to  discharge  the  latter  by  standing  on  an  in- 
sulating substance  (rubber,  glass)  or  by  placing  on  the  head 
any  red  material  so  as  to  include  both  psychomotor  regions 


Here,  it  may  be  mentioned  parenthetically,  if  you  desire 
to  prevent  the  escape  of  energy  from  a  neurasthenic,  you 
may  do  sc  by  a  strip  of  yellow  across  the  head  so  as  to  include 
both  psychomotor  regions. 

This  strip  of  yellow  prevents  the  discharge  of  energy 
from  all  of  the  energeiagenic  centers  and  in  no  wise  inter- 
feres with  the  reception  of  energy  from  the  environment. 

Do  not  subject  this  simple  expedient  to  theoretic  criti- 
cism until  you  have  given  it  a  trial. 

Individuals  who  spontaneously  discharge  energy  or  those 

66 


Discharge     of    Energy     Without     Conductors 

insulated  after  the  manner  cited  may,  by  applying  the  finger 
at  different  vertebral  spines  (where  visceral  reflexes  (7)  are 
discharged)  provoke  the  reflexes  in  question. 

Here  is  a  subject  on  whom  this  can  be  demonstrated. 

You  will  observe  that  when  this  physician  placed  his 
finger  at  the  yth  cervical  spine,  he  elicited  the  heart  reflex  of 
contraction  (199). 

I  shall  now  ask  him  to  place  his  finger  at  the  5th  dorsal 
spine  and  you  note  that  the  stomach  becomes  tipped  (demon- 
stration by  percussion). 

At  the  latter  vertebral  point  you  open  the  pylorus  (588, 
82)  and  the  stomach  empties  its  contents  into  the  duodenum. 

Dr.  Patrick  O'Donnell,  who  has  achieved  fame  as  a 
Roentgenologist,  like  many  others  doubted  the  correctness 
of  this  observation  but  he  has  repeatedly  demonstrated 
by  skiascopy  and  skiagraphy,  the  correctness  of  this  clinco- 
physiologic  phenomenon.  The  latter  will  be  demonstrated 
by  the  fluoroscope  (demonstration  by  Dr.  O'Donnell). 

The  "Royal  Touch"  and  the  laying  on  of  hands  for  the 
cure  of  disease  may  be  regarded  as  mythical  by  those  who  are 
ignorant  of  the  visceral  reflexes  and  the  potency  of  human 
energy. 

It  is  asserted  that  external  applications  do  no  good  for 
the  reason  that  there  is  no  cutaneous  absorption. 

The  latter  plays  only  a  minor  role  in  the  foregoing  method ; 
it  is  chiefly  a  matter  of  eliciting  reflexes. 

On  this  hand  placed  in  front  of  the  stomach-region,  I 
shall  rub  an  indifferent  liniment.  Observe  as  a  result  an 
immediate  elicitation  of  the  stomach  reflex. 

By  the  latter  maneuver,  frictional  energy  was  developed. 

I  constantly  discharge  a  large  amount  of  energy. 

You  know  that  the  region  for  exciting  the  depressor  nerve 
is  between  the  3rd  and  4th  dorsal  spines  (472). 

67 


Progressive      Spondylotherapy 

If  my  fingers  are  placed  at  the  latter  region  for  several 
seconds,  the  lower  border  of  the  lung  will  ascend  (473). 

You  already  know  what  can  be  done  with  a  giant  magnet 
in  visceral  attraction  and  repulsion  (156, 184,  203). 

With  this  magnet,  I  cause  the  liver  to  descend. 

If  I  now  charge  this  liver  with  the  positive  energy  of  my 
left  hand  and  attempt  to  attract  the  lower  border  of  the  liver 
with  the  positive  pole  of  the  magnet,  there  is  a  rise  in  lieu  of 
a  descent  of  the  liver  on  the  principle  that  like  charges  repel. 

There  is  a  work  by  Buchanan  on  "Therapeutic  Sarcog- 
nomy,"  which  is  a  marvelous  treatise  in  the  matter  of  de- 
ductive reasoning.  For  the  latter  reason,  it  can  never  gain 
any  scientific  distinction.  Buchanan,  however,  subjectively 
evolves  many  important  truths  concerning  human  energy 
which  he  specifies  as  Nervaura.  Thoughts  are  things.  With 
Dr.  O'Donnell's  aid  I  shall  show  you  that  pschyic  energy 
concentrated  by  aid  of  a  large  lens,  on  the  5th  dorsal  spine 
will  cause  the  stomach  to  tip  and  discharge  its  contents 
(bismuth)  into  the  duodenum.* 

Those  of  you  who  doubt  the  important  role  played 
by  color  in  physiology  and  pathology,  give  attention  to 
the  oculo-gastric  reflex  (440)  to  be  observed  in  this 
patient. 

The  patient  declares  that  any  purple  color  creates 
nausea. 

Observe  that  when  she  gazes  at  purple,  after  a  lapse 
of  several  seconds,  the  stomach  assumes  a  vertical  posi- 
tion such  as  is  noted  in  nausea  (443). 

All  forms  of  energy  are  interconvertible  and  there  is  a 
constant  circulation  of  energy  in  nature. 

Here  is  a  subject  who  discharges  no  energy,  yet  if  he  takes 

*One  of  the  observers  remarked  that  the  appearance  presented  by  the  stomach 
could  be  likened  to  the  flow  of  water  from  an  inverted  pitcher. 

68 


Discharge     of    Energy     Without     Conductors 

electrodes  for  several  minutes  in  either  hand  from  a  moder- 
ately strong  galvanic  current  and  then  directs  his  fingers  at  a 
distance  of  many  feet  from  another  subject  he  can  elicit  in 
the  latter  the  stomach  reflex.  This  ability  to  discharge 
energy  will  continue  for  several  minutes.  A  like  effect  may 
be  noted  with  the  energy  from  a  magnet  (148)  or  the  energy 
from  an  electric  lamp. 

Human  energy  passes  out  of  the  body  in  straight  lines 
and  is  partially  deflected  by  a  magnet. 

It  can  be  refracted  by  aid  of  a  double  convex  lens. 

If  the  hands  are  wet  no  energy  is  discharged  and  dry 
hands  discharge  more  energy  than  moist  hands. 

Similarly,  less  energy  is  discharged  in  humid  than  in  dry 
air. 

One  may  charge  a  Leyden  jar  with  human  energy  by 
placing  one  hand  on  the  outer  coating  of  tinfoil  and  the 
fingers  of  the  other  hand  to  the  metal  knob.  The  jar  thus 
charged  contains  an  energy  which  is  neutral. 

By  attaching  an  insulated  aluminum  or  copper  wire  to 
the  knob  the  energy  may  be  conducted  for  hours  from  the 
jar  and  the  energy  thus  conducted  may  stop  the  pulse  when 
the  end  of  the  wire  is  applied  at  the  yth  cervical  spine  or,  if 
conducted  to  the  upper  abdomen,  it  evokes  the  stomach 
reflex.  Touching  the  knob  with  the  fingers  discharges  the 
jar  and  no  more  energy  can  be  conveyed  from  the  latter. 

The  energy  output  of  an  individual  is  modified  by  many 
factors. 

Alcohol  is  one  of  the  greatest  depressors  of  the  vagus. 

By  aid  of  the  spondylopressor  (9,  34,  51,  74)  you  can 
accurately  gauge  the  depressing  action  of  alcohol. 

Note  that  before  receiving  an  ordinary  glass  of  whiskey, 
the  pulse  is  inhibited  (by  pressure  at  the  yth  cervical  spine) 
at  3^  kilograms.  Immediately  after  ingesting  the  whiskey, 

69 


Progressive      S  p  ondylotherapy 

it  takes  6  kilograms  of  pressure  to  inhibit  the  pulse  but  after 
15  minutes,  the  pulse  is  inhibited  with  a  pressure  of  i 
kilogram. 

The  effects  of  anesthetics  on  energy  may  easily  be 
determined. 

A  few  inhalations  of  chloroform  or  ether  will  inhibit  the 
output  of  energy  but  if  to  the  ether  or  chloroform,  oil  of 
orange  is  added,  I  shall  show  you  there  is  little  or  no  effect 
on  the  energy  output. 

To  Dr.  George  Jarvis,  credit  must  be  accorded  for  having 
solved  the  problem  why  oil  of  orange  is  beneficial  as  an 
addition  to  ether  in  anesthesia  (82}. 

PHOTOGRAPHIC  ACTION.* 

In  studying  the  photochemistry  of  psychic  energy  it  was 
found  to  vary  in  different  individuals.  In  those  who  spon- 
taneously discharge  large  quantities  of  energy  by  placing  a 
very  sensitive  film  (inclosed  in  a  black  envelope)  and  inter- 
posing a  medium  which  resists  the  penetration  of  psychic 
energy,  one  may  practically  always  obtain  an  impression  on 
the  film.  These  impressions  I  have  neologized  as  psycho- 
grams.  At  the  present  time  the  impressions  are  so  faint  that 
they  cannot  be  illustrated  in  this  work.  It  is  reasonable  to 
hope,  however,  that  further  experimentation  will  achieve 
better  results. 

Time  of  exposure  depends  on  the  subject  discharging 
psychic  energy.  The  most  satisfactory  time  varies  from  30 
seconds  to  5  minutes. 

**My  experiments  do  not  refer  to  mentoids  (thought  forms  or  bodies).  Yamaguchi 
refers  to  a  woman  having  the  mental  faculty  of  autohypnosis,  who  was  re- 
quested to  hypnotize  herself  and  strongly  suggest  to  herself  a  word  spelled  in 
Japanese  letters.  She  did  and  remained  hypnotized  during  one  hour.  Sensi- 
tive dry  plates  held  near  her  head,  upon  development,  revealed  the  negative 
of  the  word  spelled  in  Japanese. 

70 


Photographic     Action 

The  discharge  may  be  augmented  by  placing  a  strip  of 
red  material  across  the  head  and  the  action  of  the  psychic 
rays  on  the  plate  may  be  intensified  by  interposing  between 
the  forehead  and  the  plate  a  strip  of  aluminum.  The  mater- 
ial for  obstructing  the  rays  may  be  a  thin  layer  of  shellac  or 
the  insulating  tape  used  by  electricians.  The  shellac  may 
be  painted  on  the  forehead  or  envelope  (prior  to  the  intro- 
duction of  the  film),  and  similar  disposition  may  be  made  of 
the  tape. 

I  have  endeavored  to  obtain  similar  pictures  of  the  bones 
of  the  hand. 

The  results  thus  far  have  not  been  satisfactory  but  there 
is  reason  to  believe  that  further  efforts  with  new  developers 
may  eventually  be  successful. 

The  hand  is  placed  on  the  film  or  plate  and  covered 
with  a  sheet  of  aluminum.  The  fingers  of  one  hand 
touch  the  center  of  a  large  lens  (in  focus)  which  is  placed 
directly  over  the  object  to  be  photographed.  The  time 
of  exposure  depends  on  the  individual  discharging  en- 
ergy and  is  usually  about  5  minutes.  The  quantity  of 
energy  discharged  may  be  augmented  by  wearing  a  strip 
of  red  across  the  head  and  insulating  the  feet  by  aid  of 
rubber,  glass  or  shellac. 

The  HUMAN  AURA  so  adequately  portrayed  by  Dr. 
Walter  J.  Kilner  in  his  work,  "THE  HUMAN  ATMOSPHERE," 
is  evidently  only -a  discharge  of  energy.* 

My  investigations  show  that  the  aura  may  be  augmented 
in  area  and  density  by  concussion  of  the  7th  cervical  spine 
(164). 


*In  a  letter  received  from  Dr.  Kilner,  the  latter  makes  the  following  observation; 
"Your  opinion  that  the  aura  is  only  energy  emanating  from  the  body  corre- 
sponds entirely  with  mine,  only  I  have  expressed  it  in  a  different  manner.  I 
have  tried  to  see  it  on  *he  dead  body  but  have  always  failed  to  do  so." 

71 


Progressive     Spondylotherapy 

The  utilitarian  of  the  future  will  not  permit  human 
energy  to  go  to  waste. 

Permit  me  to  show  you  how  it  may  now  be  utilized  in 
TOPOGRAPHIC  PERCUSSION. 

The  heart  and  aorta  discharge  energy.  By  means  of  an 
insulated  cord  to  the  stomach-region,  note  that  when  I 
approach  the  borders  of  the  aorta  and  heart  with  the  other 
tip  of  the  cord,  an  immediate  dulness  of  the  stomach  ensues. 

After  this  manner  demarcation  of  the  organs  discharging 
energy,  notably,  the  right  border  of  the  heart,  is  compara- 
tively easy. 

SEXUAL  POLARITY. 

The  present  tendency  is  to  refer  all  phenomena  to  a 
sexual  basis  and  the  odd  and  even  numbers  are  regarded  as 
the  mathematical  sexes. 

Anatomy  has  heretofore  been  invoked  to  differentiate  the 
sexes. 

If  I  appeal  to  the  electronic  theory,  there  can  be  no  abso- 
lute differentiation. 

Humans  are  mere  aggregations  of  electrons  and  there 
must  be  transitional  forms  of  humans  just  as  there  are 
transitional  forms  of  metals  and  non-metals. 

It  has  been  sugge  >ted  by  Steenstrup,  that  sexual  char- 
acters are  present  in  every  part  of  the  body  and  that  every 
cell  in  the  body  has  its  definite  sexual  significance. 

The  electrons  characterizing  masculinity  and  femininity 
are  so  grouped  that  definite  areas  in  a  woman  provide  a 
sexual  stimulus  for  the  male  and  definite  areas  of  the  latter 
for  the  female. 

The  law  of  sexual  attraction,  "that  every  male  type  has 
its  female  counterpart  with  regard  to  sexual  affinity"  appears 
to  me  to  be  based  on  the  definite  law  that,  "Like  poles  repel 

72 


Male       and      Female      Types      of      Polarity 

and  unlike  attract."  Sexual  attraction  and  repulsion  must 
obey  this  law. 

Weininger,*  referring  to  the  fertilization  of  some  sea- 
weeds, speaks  of  the  lines  of  force  between  the  opposite 
poles  of  magnets  as  no  more  natural  than  that  which  irre- 
sistibly attracts  the  spermatozoon  and  the  egg-cell. 

In  the  attraction  between  the  inorganic  substances, 
strains  are  set  up  in  the  media  between  the  poles,  whereas  in 
the  living  matter  the  forces  are  confined  to  the  organisms. 

When  the  spermatozoa  approach  the  egg-cells  they  over- 
come the  force  exercised  by  light,  hence  the  chemotactic  is 
more  potent  than  the  phototactic  force. 

Sexual  adjustment  cannot  abrogate  the  laws  of  the 
universe. 

The  adjustment  of  differences  in  potential  in  the  sexual 
sphere  are  as  inviolable  as  when  iron-sulphate  and  caustic 
potash  are  brought  together;  the  SO4  ions  leave  the  iron  to 
combine  with  the  potash. 

Attention  has  already  been  directed  to  the  differences  of 
polarity  in  the  sexes. 

We  must  first  make  clear  what  I  have  differentiated  as 
the  MALE  and  FEMALE  TYPES  of  POLARITY. 

First  localize  the  PSYCHOMOTOR  AREA  (384). 

If  the  subject  (female)  touches  the  left  psychomotor 
area  with  the  tips  of  her  fingers  of  her  left  hand  (Fig.  u), 
the  stomach  reflex  ensues  and  one  may  demonstrate  dulness 
of  her  stomach.  This  is  the  female  type  of  polarity. 

The  male  type  of  polarity  is  the  opposite  of  the  female 
type;  dulness  of  the  stomach  only  ensues  when  the  tips  of  the 
fingers  of  the  right  hand  are  placed  on  the  left  psychomotor 
area  (Fig.  12). 

*Sex  and  character. 

73 


Progressive     Spondylotherapy 

A  male  facing  a  patient  (male  or  female)  produces 
stomach  dulness  by  touching  the  left  psychomotor 
region  with  the  fingers  of  his  right  hand. 

A  female  similarly  located  with  reference  to  the 
patient  (male  or  female)  can  only  produce  like  dulness 
by  touching  the  right  psychomotor  region  with  the 
fingers  of  the  right  hand. 


FIG.  11. — Illustrating  the  female  type 
of  polarity.  Only  the  tips  of  the  fingers 
should  touch  the  psychomotor  area. 


FIG.  12. — Illustrating  the  male  type 
of  polarity. 


The  female  type  of  polarity  characterizes  the  normal 
sexual  life. 

At  the  menopause  this  type  disappears,  provided  all  sex- 
ual feeling  has  been  lost.  In  two  instances  where  the  ovaries 
had  been  removed,  the  male  type  of  polarity  was  present 
but  the  latter  could  be  reversed  to  the  female  type  when 
ovarian  extract  was  administered. 

It  would  seem  that  the  sexual  apparatus  is  merely  a 
vehicle  for  the  elaboration  of  an  internal  secretion  which  by 
its  action  on  the  electrons  of  the  body  endows  them  with  a 
distinctive  polarity. 

74 


Male       and      Female       Types      of     Polarity 

There  are  typical  and  atypical  men  just  as  there  are 
typical  and  atypical  women,  and  humans  will  eventually  be 
subjected  to  a  biologico-physiological  differentiation  of  posi- 
tive (+),  negative  ( — )  or  neutral  (O)  polarities.  Color 
as  I  conceive  it  represents  different  electrical  charges  (20 j). 

In  the  case  of  woman  whose  ovaries  were  removed,  her 
male  type  of  polarity  could  be  changed  to  the  female  type 
by  placing  a  strip  of  yellow  material  over  her  right  psycho- 
motor  area. 

Magnetic  attraction  or  repulsion  is  preceded  by 
induction. 

The  latter  refers  to  magnetization  or  electrification  in  a 
body  by  the  mere  proximity  of  magnetized  or  electrified 
bodies. 

The  induced  magnetization  or  electrification  is  always  of 
opposite  kind  to  that  of  the  inducing  pole  or  body  on  the 
side  nearest  the  latter  and  of  the  same  kind  on  the  farther 
side. 

I  have  on  several  occasions  elicited  the  same  type  of 
polarity  in  husband  and  wife.  When  alone  each  presented 
the  normal  type  of  polarity.  Together,  when  the  attraction 
of  the  wife  was  greater  than  that  of  the  husband,  the  mere 
propinquity  of  the  latter  caused  in  the  wife  a  reversal  of 
polarity,  i.  e.,  a  male  type  of  polarity  by  induction.  Simi- 
lar observations  have  been  made  on  men  who  demonstrated 
a  preponderance  of  affection  for  their  wives. 

Is  affection  only  a  question  of  polarity? 

Can  the  sex  problem  be  solved  by  the  foregoing 
observations? 

Can  we  predict  sex  by  the  type  of  polarity  shown  oy  the 
pregnant  woman? 

These  are  the  problems  which  we  must  investigate. 

They  await  demonstration  by  repeated  observations. 

75 


Progressive     Spondylotherapy 

Draw  an  imaginary  transverse  line  from  the  anterior 
superior  spine  of  the  ilium  to  the  linea  alba.  Midway 
between  this  line  on  both  sides  an  area  (approximately  2 
inches  in  circumference)  is  found  which  discharges  positive 
energy*.  This  area  changes  when  the  ovary  is  dislocated. 
The  total  energy  contained  in  matter  depends  on  the  ex- 
tent to  which  it  can  be  changed.  Here  change  predicates 
functional  capacity  and  if  an  ovary  discharges  no  energy, 
its  incapacity  may  be  functional  or  due  to  disease. 

Is  HOMO-SEXUALITY  (sexual  inclination  toward  members 
of  the  same  sex)  a  mere  question  of  polarity? 

My  limited  observations  incline  toward  the  latter 
opinion. 

Several  homo-sexualists  whom  I  examined  demonstrated 
the  female  type  of  polarity.  In  not  one  of  these  individuals 
could  I  change  the  polarity  by  administering  the  different 
extracts  of  the  testicle. 

If  however  yellow  material  was  placed  over  the  right 
psychomotor  area  or  the  latter  was  painted  with  some 
yellow  solution  (gamboge),  the  polarity  could  be  reversed 
to  the  normal  male  type. 

Up  to  the  time  of  writing  two  homosexualists  in  whom 
this  maneuver  was  tried  no  change  in  the  sexual  feeling  was 
noted. 

Sexual  differentiation  is  never  absolute.  There  is  a 
permanent  bisexual  condition,  however  vestigial  and 
rudimentary. 

If  I  suggest  to  an  individual  in  an  hypnotic  condition 
that  he  is  a  woman  and  endowed  with  some  of  her  attributes, 
I  can  reverse  his  polarity  to  that  of  the  female.  I  have 


*Determined  by  dulness  of  the  stomach  when  a  connection  is  established  between 
this  region  and  the  epigastrium  by  aid  of  an  insulated  cord  of  copper. 

76 


Homo-Sexuality 

frequently  reversed  this  polarity  by  suggestion  even  in  the 
non-hypnotic  state. 

If  I  approximate  a  male  plant  to  the  epigastrium,  a 
dulness  of  the  stomach  ensues  and  one  can  determine  that 
the  energy  discharged  from  the  plant  is  negative. 

Like  experiments  with  female  plants  demonstrate  a 
'positive  discharge  of  energy. 

If  a  strip  of  yellow  is  placed  on  the  right  side  of  the 
plant,  the  polarity  of  a  female  plant  is  changed  to  that  of  a 
male  plant  and  a  male  plant  to  that  of  a  female  plant.  By 
keeping  the  yellow  strip  on  the  right  side  of  a  male  fern  for 
several  weeks,  it  presented  all  the  characteristics  of  a  female 
fern. 

If  one  end  of  an  insulated  conducting  cord  is  placed  at 
the  meatus  of  the  penis  and  the  other  metal  end  (insulated 
except  at  the  extreme  tip)  in  proximity  to  the  stomach  ,the 
latter  becomes  dull  on  percussion  and  there  is  a  retraction 
of  the  organ  in  proportion  to  the  energy  discharged  from  the 
penis.  . 

In  individuals  with  strong  sexual  power,  this  retraction 
was  as  much  as  3  cm. 

In  cases  of  IMPOTENCY  the  energy  discharged  is  not 
sufficient  to  elicit  the  stomach  reflex. 

From  both  testicles,  there  is  a  discharge  of  positive 
energy. 

If  one  of  the  testicles  is  made  functionless  in  consequence 
of  previous  disease  it  yields  no  discharge  of  energy. 

In  the  child  before  the  advent  of  puberty  no  sexual 
polarity  by  my  method*  can  be  demonstrated. 


*Vide  methods  of  determining  male  and  female  types  of  polarity. 


Progressive     Spondylotherapy 


DIAGNOSIS   OF  THE   SEX  OF  THE  FETUS. 

This  is  one  of  the  possibilities  of  the  future  based  on  the 
determination  of  the  polarity  of  the  subject. 

The  determination  of  fetal  sex  at  one  tune  advocated 
has  been  abandoned  as  unreliable. 

It  was  based  on  the  supposition  that  a  rate  of  120 — 140 
in  the  minute  of  the  fetal  heart-beat  indicated  the  probabil- 
ity of  a  male  fetus  whereas  a  more  rapid  heart-beat  was 
indicative  of  a  female  child.  The  variability  in  the  fetal 
heart-rate  makes  the  foregoing  untenable. 

The  discharge  of  energy  from  the  tips  of  the  ringers 
varies  in  both  sexes.  In  the  male  subject  the  fingers  of  the 
right  hand  discharge  negative  energy  whereas  the  left  hand 
discharges  positive  energy. 

This  is  reversed  in  the  normal  female;  fingers  of  right 
hand,  positive  energy;  fingers  of  the  left  hand,  negative 
energy. 

These  types  are  reversed  in  left  handed  individuals. 

These  types  are  not  demonstrable  in  either  sex  before 
puberty. 

These  types  are  usually  maintained  in  ambidextrous 
individuals. 

These  types  are  usually  lost  at  the  menopause  and  in 
elderly  males. 

In  syphilitics,  no  polarity  after  the  method  to  be  shown 
can  be  demonstrated. 

In  the  norm  if  a  male  extends  the  fingers  of  his  left  hand 
directly  on' a  line  with  the  exposed  epigastrium  of  another 
individual  (male  or  female)  at  a  distance  of  one  or  more 
feet,  the  stomach  reflex  (as  elicited  by  dulness)  may  be 
demonstrated  (Fig.  13).  This  dulness  is  maintained  only 
during  the  time  the  fingers  are  extended. 

78 


Diagnosis     of     the     Sex     of    the     Fetus 

The  latter  dulness  can  only  be  provoked  by  the  female 
when  the  fingers  of  the  right  hand  are  extended. 

In  those  incapable  of  discharging  energy,  some  red 
material  placed  across  the  psychomotor  areas  (192)  will 
excite  the  discharge. 

In  the  prediction  of  sex,  the  pregnant  woman  extends 
first  one  and  then  the  other  hand  in  the  direction  of  the 
exposed  epigastrium  of  another  individual  in  whom  per- 
cussion is  executed. 


FIG.  13. — Illustrating  the  method  of  eliciting  the  stomach  reflex  by  directing 
the  extended  fingers  in  the  direction  of  the  epigastrium. 

My   investigations  of   this   method    are    limited    and 
permit  me  to  formulate  only  tentative  conclusions: 

1.  Prior  to  the  4th  month,  the  pregnant  woman  shows 
no  polarity,  i.  e.,  extension  of  either  the  right  or  the  left 
hand  fails  to  elicit  dulness  of  the  stomach. 

2.  After  the  4th  month,  if  the  extended  fingers  of  the 
right   hand   evoke   stomach-dulness    (normal   polarity),   a 
female  fetus  may  be  diagnosticated. 

3.  If  after  the  same  period  only  the  extended  fingers 
of  the  left  hand  cause  stomach-dulness,  a  male  issue  may 
be  predicted. 

79 


Progressive     Spondylotherapy 

4.  For  a  variable  period  after  confinement,  no  polarity 
can  be  demonstrated  by  the  foregoing  method. 

The  following  incomplete  record  has  been  made  by  the 
author: 


DATE 

DURATION  OF 
PREGNANCY 

PLACE 

POLARITY 

PREDICTION 

RESULT 

Oct.  9, 

1913 

Mrs.  T. 

6  months 

Kansas  City 
(Dr.  Craig) 

Female 

Female 

Female 

Oct.  9, 

1913 
Mrs.  C. 

6  months 

Kansas  City 
(Dr.  Craig) 

Male 

Male 

Male 

Oct.  9, 

1913 
Mrs.  V. 

3  months 

Kansas  City 

No 
polarity 

Oct.  20, 

1913 

Mrs.  L. 

7  months 
Patient  yields 
electronic  test  for 
syphilis 

San  Francisco 
(Df.  G.) 

No 
polarity 

Oct.  17, 

i9J3 
Mrs.  E. 

9  months 

San  Francisco 
(Patient  of  Dr. 
Koerber) 

Male 

Male 

Male 

Oct.  20, 

1913 
Mrs.  G. 

9  months 

San  Francisco 
Mt.  Zion  Hos- 
pital 

Female 

Female 

Female 

Nov.  7, 

1913 
Mrs.  J. 

9  months 

San  Francisc* 
City  &  County 
Hospital 

Female 

Female 

Female 

Nov.  7, 

1913 
Mrs.  S. 

9  months 

San  Francisco 
City  &  County 
Hospital 

Male 

Male 

Male 

Investigations  should  be  instituted  to  determine  if 
absence  of  polarity  (if  previously  present)  may  be  employed 
in  the  early  diagnosis  of  pregnancy. 


80 


Determination      of    Sex 


DETERMINATION  OF  SEX. 

The  law  governing  the  production  of  sex  has  been  the 
subject  of  much  speculation.  Hippocrates  believed  that  the 
right  ovary  produced  boys  and  the  left  ovary,  girls.  In 
accordance  with  the  foregoing  women  who  desired  male 
offspring  should  during  coitus  lie  on  the  right  side  and  vice 
versa.  The  question  of  sex  is  dictated  by  two  theories;  the 
one  supposing  that  sex  is  determined  before  impregnation; 
the  other,  that  the  embryo  is  possessed  of  the  elements  of 
both  sexes  until  either  one  acquires  a  dominant  influence  in 
consequence  of  factors  present  during  early  pregnancy. 
The  latter  theory  has  been  evolved  from  a  study  of  lower 
animals  and  plants  and  is  supported  by  the  fact  that  the 
elements  of  both  sexes  in  the  human  embryo  are  apparently 
present  in  equal  force  at  the  commencement  of  embryonal 
life.  Reference  has  already  been  made  to  the  author's 
experiments  concerning  the  sexuality  of  plants  and  it  is 
mere  conjecture  which  prompts  him  to  suggest  the  possi- 
bility that  wearing  any  material  of  yellow  over  the  right 
psychomotor  area  (which  reverses  polarity  from  the  female 
to  the  male  type)  soon  after  conception  until  the  4th  month 
may  eventuate  in  a  male  issue. 

In  pregnancy  before  the  third  month,  even  though  po- 
larity is  absent,  a  male  type  of  polarity  may  be  demon- 
strated when  yellow  material  is  placed  over  the  right 
psychomotor  area. 


81 


Progressive     Spondylotherapy 

NEW  CONCEPTS   IN   DIAGNOSIS. 

THE    PRACTICAL   APPLICATION    OF    THE    ELECTRONIC    THEORY 
IN  THE  INTERPRETATION  OF  DISEASE. 

ELECTRONIC  PATHOLOGY. 

The  creation  of  a  modern  pathology  based  on  my  in- 
vestigations respecting  the  recognition  of  energy  and  its 
polarity  evolved  in  different  diseases  seems  apposite.  I 
am  also  utilizing  human  energy  in  the  treatment  of  various 
diseases  with  most  encouraging  results  but  several  years 
must  elapse  before  my  investigations  concerning  "ELEC- 
TRONOTHERAPY"  can  be  published.  Each  atom  of  our  or- 
ganism is  endowed  with  a  definite  vibration-rate. 

Just  as  there  is  a  "Periodic  Law"  with  reference  to  the 
periodicity  of  the  atoms  of  the  elements  so  may  we  antici- 
pate a  law  with  relation  to  morbid  processes  (500).  The 
periodic  law  emphasizes  the  relationship  of  atoms  and 
periodicity  of  properties  and  shows  that  family  relationships 
of  atoms  is  as  assured  as  are  the  organisms  of  the  biologist. 
At  present  I  am  attempting  to  determine  the  vibration-rate 
in  different  structures  but  cannot  as  yet  present  concrete 
data.  We  must  at  present  content  ourselves  in  determining 
the  energy  evolved  in  a  quantitative  and  qualitative 
direction. 

The  former  is  determined  by  the  intensity  of  the  stomach 
reflex  (retraction  of  the  organ)  plus  the  distance  at  which 
it  is  discharged  from  the  source  of  energy  (conductor)  and 
the  latter  refers  to  the  polarity  of  the  energy. 

In  disease  like  hi  health,  the  discharged  energy  may  be: 

1.  Positive. 

2.  Negative. 

3.  Positive  and  negative. 

4.  Neutral  or  isoelectronic. 

82 


Diagnosis     of     the     Sex      of     the       Fetus 

All  the  forces  in  nature  are  positive  and  negative. 

We  do  not  know  what  positive  electricity  really  is. 

However,  if  you  conduct  the  energy  evolved  from  the 
positive  pole  of  a  galvanic  current  by  means  of  a  single 
cord  to  the  stomach-region,  a  stomach  reflex  is  evoked  and 
and  it  can  be  shown  that  the  conveyed  energy  is  actually 
positive  in  character. 

By  aid  of  the  commutator,  you  can  produce  a  negative 
form  of  energy. 

A  unit  of  negative  electricity  in  motion  carries  with  it 
some  of  the  surrounding  ether.  It  is  this  bound  ether  plus 
the  moving  negative  unit  which  we  call  mass. 

As  before  remarked  the  atom  is  a  sphere  of  positive 
electrification  enclosing  negatively  electrified  corpuscles 
and  the  negative  electricity  of  the  corpuscles  exactly  bal- 
ances the  positive  electricity  of  the  enclosing  sphere. 

We  are  confronted  with  another  problem,  viz.,  the 
arrangement  of  the  corpuscles  in  the  sphere.  The  arrange- 
ment of  the  corpuscles  in  groups  to  form  atoms  confers  on 
the  latter  their  specific  attributes. 

If,  owing  to  some  external  disturbance,  one  or  more 
corpuscles  within  the  sphere  is  detached,  then  the  atom 
will  assume  a  positive  charge  owing  the  loss  of  a  negative 
corpuscle. 

The  stability  of  an  atom  is  dependent  on  the  number 
of  corpuscles  it  contains. 

When  the  stability  of  an  atom  becomes  extreme  the 
corpuscles  of  the  outer  ring  may  lie  on  the  surface  of  the 
atom  in  which  case  it  assumes  a  negative  charge. 

In  other  instances  the  atom  becomes  neither  electro- 
positive nor  electro-negative. 

The  configurations  of  the  corpuscles  in  an  atom  depend 
in  general  on  the  energy  they  contain.  If  the  corpuscles 

83 


Progressive      Spondylotherapy 

rotate  with  a  velocity  beyond  a  critical  period,  they  slowly 
biit  surely  lose  their  energy  and  then  there  occurs  a  sudden 
convulsion  or  explosion  with  the  evolution  of  a  large  quan- 
tity of  kinetic  energy. 

When  the  crash  comes,  this  atomic  cataclysm  results 
in  disintegration. 

I  fully  realize  that  I  have  given  you  an  incomplete  pic- 
ture of  intra-atomic  energy  and  atomic  disintegration. 

My  real  object  in  exploiting  the  electronic  theory  is  to 
account  for  the  augmented  energy  and  changes  in  the  po- 
larity of  the  latter  occuring  in  certain  diseases. 

The  molecules  of  our  body  consist  of  more  than  a  thou- 
sand atoms  and  the  atoms  themselves  are  grouped  and  re- 
grouped and  then  grouped  again  in  such  a  way  as  to  make 
the  molecules  of  the  body  highly  mobile  and  quite 
unstable. 

The  slightest  external  disturbance  will  change  the  sta- 
bility of  the  atom  and  it  will  assume  a  positive,  neutral  or 
negative  discharge  of  energy. 

With  the  discovery  of  radium,  a  new  property  of  matter 
known  as  radioactivity  was  discovered.  It  meant  that 
matter  possessed  the  property  of  emitting  rays. 

Then  followed  a  differentiation  of  the  rays  into  alpha 
(positively  charged),  beta  (negatively  charged)  and  gamma 
(neutral)  rays. 

My  physiologic  reaction  (stomach  reflex),  shows  that 
radioactivity  is  not  limited  to  radioactive  elements  but 
that  it  is  a  universal  property  of  matter. 

NEOPLASMS. 

My  observations  have  this  far  been  limited  to  the  diag- 
nosis of  carcinomata. 

The  method  of  procedure  may  be  illustrated  as  follows 

by  citing  two  cases: 

84 


Neoplasms 

A  patient  has  only  recently  observed  a  vaginal 
discharge. 

One  end  of  a  conducting  cord  was  fixed  by  the  patient 
in  the  region  of  the  lower  border  of  the  stomach*  which 
was  previously  defined  by  percussion  and  its  border  marked 
by  a  dermograph. 

The  other  metallic  end  (which  is  insulated  except  at  its 
extremity  which  is  brought  into  apposition  with  the  skin) 
was  gradually  passed  over  the  abdomen  until  a  site  was 
attained  which  yielded  stomach-dulness.  The  latter  was 
demonstrated  just  above  the  symphysis  pubis  occupying 
an  area  about  the  size  of  a  dime. 

The  polarity  of  the  energy-discharge  was  found  to  be 
negative"]'. 

Dr.  C.  G.  Levison,  made  the  gynecologic  examination 
and  found  a  polypoid  mass  protruding  from  the  cervix 
uteri  which  on  examination  by  the  pathologist,  Dr.  Dannen- 
baum  was  found  to  be  a  perithelioma.  At  the  operation 
(performed  by  Dr.  V.  G.  Vecki)  the  cervix  was  densely 
infiltrated  and  indurated  throughout  its  entirety.  The 
body  of  the  uterus  was  not  implicated. 

A  woman  occasionally  passes  blood  in  the  urine  with 
symptoms  suggestive  of  vesical  hematuria. 

A  negative  discharge  of  energy  may  be  led  off  at  a  point 
to  the  left  side  one  inch  above  the  symphysi  pubis  as  re- 
vealed by  stomach-dulness  plus  retraction  of  the  lower 
border  of  the  organ.  A  cystoscopic  examination  by  Dr. 


This  metallic  tip  may  be  fixed  to  the  skin  by  means  of  adhesive  plaster.  The 
patient  must  stand  on  a  flooring  of  wood  or  other  non-insulated  substance. 

tThe  polarity  of  energy  (153, 154)  may  be  determined  by  a  bar-magnet.  If  dulness 
of  the  stomach  is  elicited  by  conveyed  energy  from  the  morbid  site,  have  an 
assistant  or  the  patient  hold  first  one  end  marked  N  (positive)  and  then  the 
other  end  marked  S  (negative  pole)  in  the  direction  of  the  stomach  during 
percussion.  If  the  dulness  persists  with  the  N  pole  and  is  dissipated  by  the  S 
pole,  the  energy  conveyed  is  positive.  The  opposite  also  holds  good. 

85 


Progressive      Spondylotherapy 

V.  G.  Vecki,  revealed  a  supposititious  malignant  growth  at 
the  left  ureteral  opening.* 

One  could  multiply  such  records  in  carcinoma  and  other 
affections  corroborated  by  necropsy,  skiagrams,  operations 
and  iristologic  examinations.  Thus  Dr.  Geo.  O.  Jarvis 
writes  "diagnosticated  cancer  of  the  uterus  which  was 
confirmed  at  the  operation.  It  gave  little  evidence  of  its 
presence  beyond  the  electronic  reaction." 

In  the  diagnosis  of  visceral  malignancy,  there  are  at 
least  eleven  diagnostic  methods  ranging  from  the  anti- 
trypsinic  properties  of  the  blood  to  the  meiostagmin  test. 
It  is  not  my  purpose  to  deprecate  these  methods  as  imprac- 
ticable or  unreliable  but  to  emphasize  'the  fact  that  the 
methods  aim  at  generalized  in  lieu  of  localized  diagnoses. 

My  observations  on  polarity  seem  to  clarify  several 
problematic  questions  concerning  neoplasms. 

"The  vast  assemblages  of  atoms  comprising  the  heaviest 
atoms  are  unstable.  As  their  kinetic  energy  decreases  the 
aggregation  explodes  and  the  corpuscles  rearrange  them- 
selves with  the  evolution  of  energy  and  the  projection  of 
some  of  the  products  of  the  rearrangement."  The  slightest 
external  disturbance  will  alter  the  stability  of  the  atom. 

In  other  words,  irritation  is  the  most  frequent  etiologic 
factor  in  carcinoma. 

At  the  period  of  life  when  neoplasms  develop  most  fre- 
quently, one  finds  a  decrease  in  the  discharge  of  energy. 

The  polarity  of  the  energy  in  cancer  is  negative. 

It  is  a  physiologic  fact  that  every  active  or  injured  part 
shows  a  negative  electrical  reaction  toward  every  other 
part  which  is  at  rest  or  inactive. 


*Six  weeks  after  transference  of  her  own  energy  to  the  site  of  the  lesion,  a cystoscopic 
examination  by  Dr.  Vecki  revealed  the  disappearance  of  the  bladder-tumor. 

86 


N        e         o        p        I        a        s        m        s 

If  we  apprehend  malignancy  from  the  viewpoint  of  the 
physicist,  one  must  assume  that  the  discharged  energy  is 
due  to  chemical  dissociation  of  atoms  into  negative  and 
positive  ions  and  electrons. 

A  tissue  at  rest  is  in  a  condition  of  electric  equilibrium 
(isoelectric). 

If  this  equilibrium  is  disturbed  by  some  traumatic  fac- 
tor, a  difference  of  potential  is  established  and  the  altered 
tissue  becomes  electronically  negative  to  the  normal.  The 
sensitive  living  cells  are  at  the  mercy  of  their  environment 
and  this  refers  in  all  cogency  to  changes  in  the  constituent 
elements  of  the  fluids  in  which  they  are  bathed. 

The  beneficent  action  of  radium  on  new  growths  is  not 
explained. 

The  gamma  or  neutral  rays  are  the  most  efficient  in 
reestablishing  a  normal  cell-balance  in  carcinomata. 

The  beta  rays  (negative)  stimulate  cell-growth  and  have 
been  shown  to  augment  the  growth  of  carcinomata. 

From  the  data  already  presented  it  does  not  seem  diffi- 
cult to  explain  the  action  of  radium. 

Cancer  developing  in  people  who  live  together  (cancer 
a  deux)  suggests  contagion. 

Just  as  radium  confers  radioactivity  on  other  substances, 
so  may  a  cancerous  person  by  induction  alter  the  polarity 
of  another  individual. 

Thus,  if  the  negative  energy  from  a  cancer  is  conveyed 
to  the  stomach  of  a  normal  individual,  the  stomach-dulness 
of  the  latter  may  persist  for  some  time  after  the  source  of 
energy  is  removed  and  it  will  be  found  to  possess  a  negative 
polarity. 

In  carcinomatosis  (generalization  of  cancerous  growths), 
the  arteries  which  in  the  norm  yield  a  positive  energy 
demonstrate  a  negative  energy. 

87 


Progressive     Spondylotherapy 


SUMMARY. 

1.  The  electronic  diagnosis  of  cancer  is  an  early  sign. 
Cancer  in  its  early  stage  irrespective  of  its  localization 

is  apparently  an  insignificant  lesion  (Bloodgood),  hence  the 
importance  of  an  early  diagnosis. 

The  condition  in  question  corresponds  to  what  was  once 
called  the  pre-cancerous  stage  which  is  in  reality  cancer 
without  positive  signs. 

Morbid  cell-activity  may  temporarily  discharge  a  nega- 
tive energy  as  I  have  occasionally  observed  in  gastric  and 
duodenal  ulcer  but  this  variety  of  energy  ceases  when  the 
condition  is  improved.  The  present  morphologic  concep- 
tion of  a  neoplasm  is  destined  to  be  supplanted  by  an  elec- 
tronic conception  when  energy-discharge  will  signalize  a 
tendency  toward  the  development  of  a  neoplasm. 

2.  The   energy-discharge   in   cancer   is   negative   and 
provokes  the  stomach  reflex  of  contraction. 

The  degree  of  malignancy  may  be  gauged  by  the  ampli- 
tude of  retraction  of  the  lower  border  of  the  stomach. 

3.  The  electronic  test  localizes  with  exactitude  the  area 
involved  and  metastases  if  present  may  be  demonstrated. 

4.  At  the  time  of  the  operation,  the  electronic  test  may 
be  employed  to  indicate  the  extent  of  invasion  and  to  show 
that  the  involved  tissues  have  been  extirpated. 

5.  It  is  best  to  employ  another  subject  in  executing 
the  test  and  to  select  one  in  whom  the  stomach  reflex  is 
normal  and  not  easily  exhausted. 

6.  In  eliciting  the  electronic  reaction  proximity  of  the 
subject  to  intense  light  must  be  avoided  (127),  light  being 
a  form  of  energy  is  capable  in  itself  of  evoking  the  stomach 
reflex. 

7.  When  pain  is  present  a  neutral  energy  may  be  elic- 

88 


Summary 

ited.    This  reaction  of  real  pain  may  be  utilized  in  differen- 
tiating it  from  pseudo-pains  in  malingerers. 

8.  In  testing  for  normal  or  abnormal  energy,  the  sub- 
ject must  be  grounded  (either  patient  or  subject  on  whom 
the  test  is  made).    If  the  patient  or  the  subject  stands  on 
insulated  material  (porcelain,  varnished  floor,  glass,  etc.),  no 
stomach  reflex  is  obtainable.    The  latter  is  important  when 
the  tests  are  executed  in  an  operating  room  with  a  floor  of 
porcelain  tiling.    In  such  instances  the  subject  and  patient 
must  be  grounded  by  a  single  wire  from  the  foot  to  a  con- 
venient faucet  or  radiator. 

9.  The  presence  of  fluid  in  the  stomach  or  bladder 
yields  a  neutral  discharge  of  energy,  hence  these  organs  must 
be  empty  before  conclusions  are  formulated. 

10.  The  process  of  elimination  must  be  exercised  in 
every  possible  direction.    Thus,  a  kidney  which  yields  in 
the  norm  a  negative  energy  may  simulate  a  neoplasm  if 
luxated. 

NORMAL  AND  PATHOLOGICAL  ENERGY. 

In  the  employment  of  electronic  diagnosis  the  following 
facts  will  assist  in  the  recognition  of  normal  and  abnormal 
energy : 

1.  Normal  energy  may  be  determined  by  its  polarity. 

2.  A  few  whiffs  of  chloroform  will  at  once  dissipate 
normal  energy,  i.  e.,  it  is  insufficient  in  potential  to  evoke 
the  stomach  reflex  whereas  no  amount  of  chloroform  ap- 
pears to  deprive  abnormal  energy  of  eliciting  the  same  reflex. 
Even  under  complete  anesthesia  the  energy  discharged  from 
neoplasms  persists. 

3.  To  convey  sufficient  normal  energy  to  elicit  the 
stomach  reflex,  the  tip  of  the  cord  must  be  in  contact  or 
not  in  excess  of  one  inch  from  the  part  supplying  the  energy. 

89 


Progressive     Spondylotherapy 

Morbid  energy  however  may  still  be  conducted  even 
though  the  metallic  tip  of  the  conductor  is  more  than  one 
inch  distant  from  the  source  of  energy-supply. 

4.  When  the  stomach  is  the  object  of  investigation 
another  subject  should  be  selected  for  the  elicitation  of  the 
stomach  reflex. 


SYPHILIS. 

Since  the  discovery  of  the  spirocheta  pallida,  this  organ- 
ism has  been  found  in  the  brain  of  paretics  and  in  the  cord 
in  tabetics.  Many  tests  have  been  suggested  for  syphilis: 

i.  Complement  fixation  or  deviation  test  of  Wasser- 
mann;  2.  Noguchi  or  butyric  acid  reaction;  3.  Cobra  venom 
hemolysin  test. 

4.  Control  of  the  Wassermann  by  measuring  the  amino- 
nitrogen  of  the  blood-serum; 

5.  Luetin  reaction. 

In  the  Noguchi-luetin  reaction,  the  test  is  not  appli- 
cable in  the  primary  and  secondary  stage;  the  chief  response 
is  in  the  treated  and  late  cases. 

The  Wassermann  is  not  absolutely  specific  for  syphilis 
insomuch  as  it  is  not  dependent  on  syphilitic  antibodies  in 
the  blood  but  upon  admission  to  the  latter  of  abnormal 
products  from  morbid  tissues. 

The  Wassermann  reaction  has  been  found  positive  in 
scarlatina,  appendicitis,  cancer,  typhoid,  sepsis,  phthisis, 
diabetes  and  other  diseases. 

The  electronic  reaction  for  syphilis  (congenital  and  ac- 
quired), is  as  follows: 

Energy  conducted  from  the  liver,  spleen  and  vertebral 
column  (site  selected,  yth  dorsal  spine),  causes  a  stomach 
reflex  (ascertained  by  dulness)  and  the  dulness  is  dissipated 

90 


Dementia     Paralytica 

by  the  +  and  —  poles  of  a  bar  magnet;  i.  e.,  the  energy  is 
neutral  or  isoelectronic. 

Energy  conveyed  from  the  arteries,  veins  and  heart  is 
also  neutral  but  insomuch  as  this  reaction  is  obtainable 
in  other  diseases,  the  foregoing  the  reaction  as  first  cited 
should  be  accepted. 

The  exact  site  of  the  primary  lesion  may  be  also  be  as- 
certained by  this  method*. 

Ascertaining  the  site  of  the  primary  lesion  is  of  value  as 
corroborative  evidence  and  may  aid  us  in  treatment. 

Thus  in  a  case  seen  in  consultation  with  Dr.  F.  S.  Hae- 
berle  (St.  Louis),  it  was  impossible  to  elicit  the  electronic 
reaction  after  the  primary  site  of  inoculation  was  submitted 
to  several  mercurial  inunctions. 

The  reaction  was  obtainable  in  every  case  of  syphilis 
notwithstanding  salvarsan,  neosalvarsan,  mercury  and 
various  organic  arsenic  compounds  had  been  employed.* 

The  electronic  reaction  was  positive  despite  the  fact  that 
in  many  cases  the  Wassermanh  and  luetin  reactions  were 
negative. 

DEMENTIA  PARALYTICA. 

Noguchi  demonstrated  the  spirocheta  pdllida  in  the 
stained  specimens  of  the  brain  in  general  paralysis.  Forster 
and  Tomasczewski,  demonstrated  living  spirochetes  in  8 
out  of  20  cases  examined  by  aspiration  of  the  cortical  sub- 
stance. The  author  has  examined  a  large  number  of  paretics 
and  ascertained  the  following  invariable  electronic  reaction ; 
when  a  connection  is  made  between  either  frontal  eminence 

*This  was  demonstrated  to  the  eminent  syphilologists,  G.  Frank  Lydston  of  Chicago, 
V.  G.  Vecki,  of  San  Francisco,  and  many  other  physicians. 

*In  only  five  patients  among  many  hundreds  examined,  a  negative  reaction  was 
obtainable.  Here,  it  is  interesting  to  observe  that  in  these  patients  anti- 
syphilitic  medication  was  executed  at  the  time  of  the  primary  lesion  and 
maintained  for  periods  varying  from  one  to  five  years. 

91 


Progressive     Spondylotherapy 


of  the  subject  and  the  gastric  area,  dulness  of  the  stomach 
immediately  ensues  and  the  dulness  is  dissipated  by  both 
poles  of  a  bar  magnet.  Aside  from  this  neutral  energy,  one 
may  obtain  the  same  reaction  from  the  liver,  spleen  and 
spine. 


FIG.  14. — Illustrating  the  cerebral  sinuses  and  psychomotor  area  (4x6  cm.  in 
area)  where  energy  is  normally  discharged.  The  sinuses  yield  a  negative  discharge. 
In  the  norm  no  discharge  is  obtainable  from  the  mastoid,  a  fact  of  importance  in 
eliciting  the  reaction  for  pus. 


In  the  norm  and  in  syphilis  (without  cerebral  involv- 
ment),  no  energy  sufficient  to  dull  the  stomach  is  obtain- 
able from  the  frontal  eminences.  In  dementia  precox,  a 
positive  energy  is  obtainable  from  the  frontal  eminences. 

Great  care  must  be  exercised  in  recognizing  the  many 
areas  on  the  head  from  which  energy  is  normally  discharged 
(Fig.  14). 

92 


Dementia     Paralytica 

Error  may  be  eliminated  by  consulting  page  41  of  this 
address  and  furthermore  by  recalling  the  fact  that  the 
energy-discharge  of  other  areas  is  positive  or  negative  and 
not  neutral  as  in  syphilis. 

It  is  true  however,  that  if  the  tip  of  the  conductor  is 
directly  over  an  artery  or  vein,  one  may  elicit  the  reaction 
of  a  neutral  energy  (in  syphilis)  but  if  the  frontal  eminence 
is  alone  selected,  errors  of  interpretation  may  be  avoided. 

The  syphilitic  shows  no  polarity  and  it  is  impossible  to 
obtain  sufficient  energy  to  dull  the  stomach  (as  in  the 
norm)  from  the  left  psychomotor  area  in  the  male  and  from 
the  right  psychomotor  area  in  the  female. 

Many  cases  of  insanity  examined  by  me  at  the  asylums 
were  found  to  be  cases  of  brain-syphilis  and  this  was  notably 
the  case  in  patients  diagnosticated  as  dementia  precox. 

The  electronic  test  is  destined  to  serve  of  great  value  in 
the  differentiation  of  a  host  of  mental  maladies. 

Already  the  serological  diagnosis  of  syphilis  bears  re- 
sults in  the  passing  of  paresis. 

The  close  relationship  between  syphilis  and  the  latter 
has  always  been  recognized  but  with  the  distinction  how- 
ever that  paresis  was  a  parasyphilitic  affection  due  to  the 
indirect  action  of  toxins  whereas  it  is  now  known  that  the 
treponema  pallidum  is  directly  concerned  in  its  production. 

The  passing  cf  parasyphilis  emphasizes  the  fact  that, 
within  a  fev  weeks  after  the  primary  inoculation  the  spiro- 
chetes  invade  every  tissue  of  the  body  and  to  prevent 
spirilloses  of  the  nervous  system  heretofore  designated  as 
parasyphilitic,  energetic  treatment  must  be  commenced 
at  the  time  of  the  primary  inoculation. 

The  foregoing  suggest  the  value  of  the  electronic  reac- 
tion in  the  early  diagnosis  of  syphilis. 


93 


Progressive     Spondylotherapy 


TUBERCULOSIS. 

It  is  generally  conceded  that  the  tuberculin  reaction  is 
a  phenomenon  of  sensitization. 

There  are  many  limitations  to  the  tuberculin  test  which 
time  will  not  permit  me  to  review. 

The  electronic  reaction  in  tuberculosis  yields  a  neutral 
energy. 

One  may  localize  with  absolute  certainty  the  site  of  the 
lesion  and  ascertain  its  area  whether  located  in  the  lung, 
larynx,  lymphatic  gland,  bone,  joint  or  other  structure. 

Observe  that  the  reaction  is  that  of  syphilis,  but  the 
reaction  cannot  be  obtained  from  the  liver,  spleen  or  spine 
(provided  these  structures  are  not  implicated  by  tubercu- 
lous lesions). 

It  may  be  difficult  for  you  to  differentiate  between  an 
active  and  a  healed  tuberculous  lesion. 

In  the  latter,  the  reaction  is  only  obtainable  when  the 
tip  of  the  cord  is  in  immediate  contact  with  the  site  of  the 
lesion,  whereas  in  an  active  lesion,  the  reaction  is  obtain- 
able when  the  tip  is  held  several  inches  away  from  the  site 
of  the  lesion. 

The  potentiality  of  the  energy-discharge  is  in  direct  ratio 
to  the  bacterial  or  toxin  content  of  the  lesion. 

When  tuberculosis  is  generalized,  the  arteries  and  veins 
yield  a  neutral  energy. 

Pus  (streptococcic  reaction)  may  be  detected  practi- 
cally anywhere  in  the  organism  and  by  the  immediate  dem- 
onstration of  these  foci  of  suppuration,  the  so-called  "cryp- 
togenetic  septicemia"  is  destined  to  be  regarded  as  an  avoid- 
able diagnostic  error. 


94 


Electronic     Reactions 


ELECTRONIC  REACTIONS. 

In  the  subjoined  table  an  attempt  has  been  made  to 
summarize  a  variety  of  affections  yielding  electronic 
reactions. 

In  erysipelas  and  meningitis,  further  control-tests  are 
necessary  before  accepting  the  reactions  as  final.  The 
reactions  in  typhoid  and  malaria  may  be  present  for  years 
after  recovery  from  the  primary  attack. 

I  must  caution  you  against  the  error  in  diagnosis  of 
accepting  as  conclusive  so-called  pathognomonic  symptoms. 

No  physician  can  assume  skill  in  diagnosis  until  he  has 
mastered  the  rules  and  principles  of  logic. 

By  aid  of  these  reactions  one  is  not  only  able  to  make  a 
diagnosis  but  it  will  be  possible  as  in  pertussis  to  localize 
the  debatable  site  of  infection. 


95 


Progressive     Spondylotherapy 


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rogress  i^e     Spondylotherapy 


EPILEPSY. 

All  theories  concerning  the  nature  of  epilepsy  are  un- 
proved hypotheses. 

The  majority  of  writers  concede  that  the  paroxysms  are 
discharged  from  the  cerebral  cortex,  notably  the  cortical 
motor  regions. 

Before  presenting  my  conclusions  concerning  a  large 
number  of  epileptics  whom  I  examined,  certain  fundamental 
facts  must  be  reviewed. 

We  know  that  from  the  left  psychomotor  area  in  the 
male  and  from  the  right  psychomotor  area  in  the  female, 
sufficient  energy  can  be  conveyed  to  the  stomach  to  evoke 
dulness  of  the  latter. 

We  also  know  that  when  the  end  of  the  connecting  wire 
is  distant  beyond  ^4  inch  from  the  psychomotor  area,  the 
energy  is  insufficient  to  elicit  stomach-dulness. 

All  epileptics  discharge  a  neutral  energy  from  both  psycho- 
motor  areas  and  this  electronic  reaction  is  characteristic 
of  this  affection.  My  measurements  show  no  increase  in 
the  energy-discharge  either  from  the  psychomotor  area 
normally  discharging  energy  nor  from  the  area  which  in 
the  norm  discharges  no  energy.  Before  puberty  where 
polarity  is  not  yet  expressed,  there  is  nevertheless  a  dis- 
charge from  the  right  psychomotor  area  in  the  male  and 
from  the  left  psychomotor  area  in  the  female. 

DIAGNOSIS   OF  DEATH. 

The  author  in  his  "Transactions  of  the  Antiseptic 
Club,"  refers  to  the  fact  that  it  is  unfortunate  that  the 
generality  of  physicians  neglected  the  important  duty  of 
diagnosing  death. 

100 


Diagnosis        of       Death 

The  application  of  one  positive  sign  of  death  should  be 
made  obligatory  by  law.  We  now  know  that  the  living 
body  constantly  discharges  energy  from  definite  areas, 
notably  the  heart-region. 

If  sufficient  energy  cannot  be  conveyed  from  the  latter 
area  to  evoke  stomach-dulness,  it  is  practically  a  certain 
sign  of  death. 


SYNOPTIC  REVIEW  OF  SPONDYLO- 
THERAPY* 


SPONDYLOTHERAPY.— This  neologise  was  primarily  employed 
in  my  book  on  this  subject,  the  first  edition  of  which  was  published  in 
1910.  It  referred  to  physiotherapy  and  pharmacotherapy  of  the  spine 
based  on  a  study  of  the  visceral  icflexes  of  Aibrams. 

Spondylotherapy  was  first  interpreted  as  the  exploitation  of  an  exclu- 
sive system  and  it  was  identified  with  osteopathy  and  chiropractic.  To 
make  confusion  worse  confounded,  some  so-called  drugless  healers  ex- 
ploited the  term  spondylotherapy  to  abet  their  exclusive  methods  of 
practice.  In  the  preface  of  my  book,  an  emphatic  protest  is  made  against 
exclusivism  in  medicine  which  is  a  composite  practice  and  demands  the 
employment  of  all  the  resources  of  science  bearing  on  the  treatment  of 
disease. 

Osteopathy  which  preceded  the  birth  of  chiropractic,  is  a  system  of 
anatomic  abnormalities  and  their  correction.  "'Its  nosology  is  a  lesion,  its 
symptomatology,  a  subluxation."  Chiropractic  presumes  disease  to  eman- 
ate from  displaced  vertebrae  which  pinch  the  spinal  nerves.  The  spinal 
centers  are  referred  to  in  osteopathic  and  chiropractic  text-books  "with  a 
dogmatism  and  certainty  'begotten  of  beneficial  results." 

.The  myth  and  fetish  of  the  dislocated  vertebra  is  nevertheless  exploit- 
ed. 1  have  made  skiagrams  of  patients  whose  vertebrae  were  said  to 
have  been  "dislocated"  by  competent  osteopaths  and  chiropractors  and  in 
not  a  single  instance  could  this  diagnosis  be  confirmed.  When  the  spinal 
manipulator  in  his  "adjustments"  elicits  the  "pop"  he  causes  the  sudden 
separation  of  ankylosed  articular  surfaces.  The  frequency  of  bands  and 
adhesions  in  joint  lesions  are  ignored  by  us;  hence  the  presitige  of  the 
spinal  manipulator. 

Spondylotherapy  concerns  itself  only  with  the  excitation  of  the  func- 
tional centers  of  the  spinal  cord  t>y  different  methods,  which  may  be" 
executed  and  demonstrated  with  the  same  certainty  in  the  living  subject 
as  is  done  by  the  vivisectional  experimentalist. 

This  phase  of  medicine,  I  have  neologized  as  clinical  physiology.  Thus 
human,  and  not  animal  physiology,  is  made  the  basis  of  clinical  physiol- 

•Reprinted  with  additions  from  the  last  edition  of  "Reference  Hand- 
book of  the  Medical  Science*."  Wm.  Wood  &  Co.,  New  York. 

103 


Progressive     Spondylotherapy 

ogy.  In  this  way,  one  may  disprove  by  clinical  observations  many 
apodictic  data  created  in  the  laboratory.  The  pathology  of  spondylo- 
therapy  (referred  to  by  J.  Madison  Taylor,1  as  reflexopathology),  is  found- 
ed on  clinical  physiology  and  its  methods  embrace  the  therapeutics  of  the 
reflexes.  The  committee  on  Standardization  of  the  American  Electro- 
therapeutic  Association,  reports  (Sept.,  1914)  as  follows: 

"In  spondylotherapy  the  employment  of  mechanical  vibration  fills  one 
of  the  most  useful  roles  in  therapeutics.  It  is  easily  controlled  and  as 
practical  and  effective  of  application  in  the  hands  of  those  familiar  with 
the  methods  of  employing  it  as  spinal  percussion." 

Each  segment  of  the  spinal  cord  must  be  regarded  as  a  unit  endowed 
with  motor,  sensory,  vasomotor,  trophic,  and  reflex  functions  with  regard 
to  the  peripheral  distribution  of  the  roots  of  the  nerves  which  emerge 
from  and  enter  it.  Man  is*  essentially  a  reflex  animal  and  even  con- 
sciousness depends!  upon  the  action  of  the  reflexes. 

The  physiologic  mechanism  designated  as  a  reflex  surpasses  in  its  sen- 
itivity  any  apparatus'  yet  devised  by  human  ingenuity  and  it  was  the  utili- 
zation of  the  reflex  which  enabled  the  writer  in  a  recent  book2  to  demon- 
strate the  electronic  nature  of  matter  and  to  advocate  supplanting  the 
archaic  cell-doctrine  -by  the  electronic  theory. 

Many  reflex  acts  are  so  perfectly  coordinated  that  one  is  constrain- 
ed to  believe  that,  in  the  spinal  cord,  there  exists  a  subsidiary  brain.  All 
diseases  are  manifested  iby  a  direct  and  indirect  symptomatology;  the 
latter  embraces  the  reflex  symptoms.  Pharmacology  and  physiotherapy 
are  utilized  in  inhibiting  or  exciting  reflexes  to  cure  disease. 

When  the  oculist  contracts  or  di'latesi  the  pupil,  he  employs  reflexes  in 
treatment.  Thus,  in  iritis,  the  most  important  remedy  is  atropine  because 
among  other  effects,  the  eye  is  put  at  rest  owing  to  the  factitious  irido- 
plegia.  Vasomotor  pharmacotherapy  is  exhibited  by  the  use  of  the 
group  of  nitrites  for  inducing  vasoconstrictor  paralysis,  or  the  ergot  group 
for  effecting  contrary  results.  Surgery  has  invaded  a  like  reflexothera- 
peutic  field  in  the  treatment  of  spasticity  by  rhizotomy.  Here,  the  object 
is  to  inhibit  afferent  impulses  from  the  muscles  which  excite  the  cells 
of  the  anterior  horns  of  the  cord  to  send  out  excessive  motor  reflexes  to 
the  muscles. 

The  mechanism  of  a  reflex  is  receptive,  conductive  (embracing  nerve 
fiber  and  central  cell),  and  effective  (action  of  the  peripheral  organ).  In 
medical  literature,  I  have  repeatedly  referred  to  certain  visceral  reflexes 
evoked  by  cutaneous  irritation.  The  reflexes*  in  question  are  endowed 
with  more  than  mere  physiologic  interest.  Such  reflexes  react  on  the  vis- 
cera and  the  reaction  may  be  utilized  in  a  diagnostic  and  therapeutic  di- 
rection. The  evidence  heretofore  adduced  in  explanation  of  the  results 
achieved  by  electric,  hydriatic,  mechanic,  and  balneary  .treatment  of  disease 

104 


Review    of    S  p  o  n  d  y  1  o  t  h  e  r  a  p  y 

was  naught  else  than  a  mere  array  of  words  conceived  only  in  conjecture. 

The  visceral  reflexes  may  be  elicited  from  forces  employed  at  the 
periphery  or  at  a  spinal  center  (over  the  segments  or  where  the  spinal 
roots  emerge).  Applied  at  the  latter  situation,  the  visceral  reflexes  are 
of  greater  amplitude  and  of  longer  duration.  It  is,  therefore,  evident 
that  in  the  treatment  of  disease  by  aid  of  reflexes,  the  elicitation  of 
central  reflexes  is  preferable. 

In  the  spinal  cord  there  are  centers  for  the  contraction  and  dilatation 
of  the  viscera.  In  the  norm,  these  centers  are  in  physiological  antagonism. 
When  neither  reflex  predominates  a  reflex  equilibrium  is  established. 
The  moment  one  reflex  gains  the  ascendancy  over  its  antagonist,  the 
reflexes  become  disequiliibrated. 

Demonstration  of  the  Visceral  Reflexes. — 'Prior  to  the  advent  of 
roentgenology,  the  conventional  physical  methods  were  employed  to 
demonstrate  the  visceromotor  reflexes  (contraction  and  dilatation  of  the 
viscera).  The  Roentgen  rays  have  given  a  decided  impetus  to  the  recogni- 
tion and  acceptance  of  the  visceral  reflexes  of  Aibrams.  Lebon  and  Au- 
bourg  presented  before  the  Societe  de  Radiologie  Medicale  de  Paris,  com- 
parative radiographs  showing  modifications  of  the  large  intestine,  after 
stimulation  of  different  vertebral  spines  by  my  methods.  They  had  ascer- 
tained upon  administering  castor  oil,  then  a  bismuth  suspension,  and 
finally  examining  the  subject  with  the  x-rays,  that  electrical  stimulation 
of  the  right  vagus  in  the  neck  caused  contractions  of  the  ascending  colon, 
sufficiently  marked  to  be  plainly  visible  on  the  screen  at  each  excitation  of 
the  nerve.  Similar  stimulation  of  the  crural  or  sciatic  nerves  produced 
little  or  no  change  in  the  colon.  Vigorous  percussion  of  the  seventh  cer- 
vical spinous  process  caused  the  cecum  to  rise  and  the  ascending  colon 
to  become  broader ;  such  effects  were  observed  in  all  persons  examined 
excepting  one — a  woman  with  marked  enterospasm  and  constipation.  Per- 
cussion of  the  dorsal  spines  had  no  effect  on  the  colon  until  the  lowest 
ones  were  reached;  percussion  of  these,  or  of  the  lumbar  spines,  brought 
about  contractions  of  the  colon  in  all  its  divisions. 

Dr.  Patrick  S.  O'Donnell  and  other  expert  roentgenoscopists  have  shown 
that,  after  the  ingestion  of  the  conventional  bismuth  meal,  it  takes  approx- 
imately one  hour  and  fifteen  minutes  for  the  stomach  to  void  its  contents, 
whereas  after  stimulation  of  the  fifth  dorsal  spine,  the  stomach  voids  the 
bismuth  in  one  and  one-half  minutes. 

Snow3  shows  by  a  series  of  excellent  skiagrams  the  diminished  volume  of 
the  heart  and  aorta  by  stimulation  of  the  seventh  spine,  and  observes; 
"The  heart,  aorta,  stomach,  liver,  or  spleen  may  be  made  to  contract 
at  the  will  of  the  operator,  producing  effects  available  for  the  correction  of 
impaired  functions.  If  the  skilled  practitioner  will  use  vibration  in  cases 
to  which  it  is  applicable,  he  will  be  rewarded  'by  results  which  cannot  be 

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Progressive     Spondylotherapy 

attained  by  drug-therapy."    A  number  of  cases  reported  by  Snow  demon- 
strate the  correctness  of  the  latter  conclusion. 

Dr.  George  Jarvis,  whose  accuracy  as  an  observer  and  skill  as  a  sur- 
geon are  conceded,  authorizes  me  to  say  that,  in  his  research  work  em- 
bracing a  new  departure  in  surgery  the  publication  of  which  is  antici- 
pated, in  anesthetized  subjects  at  the  operating  taible,  the  visceral  reflexes 
may  be  elicited  with  a  strong  sinusoidal  current  (one  electrode  at  the 
sacrum,  and  the  other  over  definite  vertebral  regions)  as  described  in 
Spondylotherapy.  The  stomach  reflex  is  elicited  (contraction  of  the  or- 
gan) to  approximately  one-fourth  of  its  original  volume.  Associated  with 
the  latter  reflex  is  a  marked  anemia  of  the  stomach.  The  gall-bladder 
reflex  of  contraction  is  likewise  evocabk. 

The  subjects  were  under  narcosis  with  nitrous-oxide  and  oxygen,  and 
in  addition,  in  some  instances,  even  scopolatnine  and  morphine  were  used. 
When  spinal  anesthesia  was  alone  employed,  although  visceral  reflexes 
could  be  elicited,  they  were  not  as  accentuated  as  under  narcosis. 

With  the  ophthalmoscope,  bronchoscope,  or  cystoscope  one  may  note 
that  one  can  at  will  produce  anemia  or  hyperemia  of  the  retina,  'bronchial 
or  vesical  mucosa,  by  stimulation  of  definite  spinous  processes. 

Methods. — For  the  purpose  of  stimulating  or  inhibiting  the  functions 
of  the  spinal  segment  or  radices  of  the  nerves,  only  brief  mention  can  be 
made  of  the  following  methods  in  order  of  efficiency: 

1.  'Concussion  or  percussion;  2.  Electricity;  3.  Pressure;  4.  Freez- 
ing. 

1.  Vibromassage  or  Mechanical  Vibration. — This  has  achieved  some 
distinction  as  a  remedial  measure,  but  owing  to  its  indiscriminate  applica- 
tion without  regard  to  physiological  principles,  most  of  the  results  at- 
tained by  its  use  must  be  attributed  to  suggestion.  The  manipulation  of 
definite  vertebral  spines  corresponds  with  the  elicitation  of  definite  re- 
flexes, but  if  the  vertebrae  are  promiscuously  handled  counter-reflexes 
are  evoked,  which  may  often  accentuate  the  reflexes  in  action  and  thus 
intensify  the  coexisting  symptoms. 

In  the  therapeutic  elicitation  of  the  visceral  reflexes  by  spinal  concus- 
sion the  only  kind  of  apparatus  which  is  effective  is  one  giving  the  percus- 
sion stroke;  all  other  motions  (oscillations,  shaking,  friction)  interfere 
with  the  results.  In  other  words,  it  is  concussion  or  percussion  and  not 
vibration  which  is  effective.  The  neurologist  utilizes  percussion  and  not 
vibration  for  eliciting  the  tendon  reflexes  and  a  like  argument  holds  when 
the  visceral  reflexes  are  solicited, 

In  the  absence  of  a  reliable  apparatus,  effective  results  may  be  achieved 
by  aid  of  a  pleximeter  and  plexor;  the  former  being  placed  in  apposition 

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with  the  vertebral  spine  and  struck  with  the  plexor.  The  results  are  even 
more  effective  with  a  pleximeter  encroaching  on  both  sides  of  a  spinous 
process. 

It  must  be  emphasized  that,  in  the  employment  of  a  stimulus),  if  the  lat- 
ter is  too  prolonged  the  visceral  reflexes  become  exhausted  and  a  con- 
dition other  than  that  sought  for  ensues. 

It  is  known  that  nerve-cells  discharge  their  motor  impulses  with  a 
rhythmicity  comparable  to  the  rhythmic  beats  of  the  heart.  Planck,  uses 
a  sinusoidal  apparatus  in  connection  with  a  compressing  armlet  thus 
enabling  the  current  to  be  delivered  rhythmically  with  each  'beat  of  the 
patient's  heart. 

2.  Electricity. — The  sinusoidal  current  is  used  almost  exclusively  by  the 
writer  for  evoking  the  visceral  reflexes.  Many  of  the  sinusoidal  machines 
cm  the  market  are  such  in  name  only  and  do  not  achieve  the  results.    The 
method  of  application  in  general  is  to  place  one  large  electrode  at  an  in- 
different point  (sacral  region),  and  the  other  over  definite  spinous  pro- 
cesses. 

Practically  all  the  tendon  reflexes  may  ibe  elicited  by  percutaneous  ap- 
plication of  a  rapid  strong  sinusoidal  current  to  definite  spinous  processes. 
The  reflexes  are  bilateral,  in  contradistinction  to  the  conventional  cutaneo- 
peripheral  reflexes,  which  are  unilateral.  This  centrotherapeutic  appli- 
cation of  stimulation  will  elicit  tendon  reflexes  in  some  instances  even 
though  they  are  otherwise  absent,  and  explains  some  of  the  immediate 
effects  secured  in  locomotor  ataxia  and  in  poliomyelitis  to  restore  nutri- 
tion of  the  implicated  muscles. 

By  sinusoidalization  of  the  skin  over  definite  regions  of  the  cortex,  using 
an  interrupting  bipolar  electrode,  it  is  possible  to  obtain  contractions  of 
the  muscles  of  the  arms  and  face. 

The  galvanic  and  faradic  currents,  the  interrupted  low-tension  current 
of  Leduc,  and  thermopenetrating  currents  are  of  little  or  no  value  in  the 
elicitation  of  visceral  reflexes  by  vertebral  excitation. 

The  high-frequency  current,  applied  by  means  of  a  double  vacuum 
electrode,  to  either  side  of  definite  spines,  will  elicit  visceral  reflexes  of 
great  amplitude  and  long  duration. 

3.  Pressure. — Visceral   reflexes   may  be   excited   by   deep   pressure  at 
the  vertebral  exits  of  the  various  spinal  nervea     Visceral  pains  and  the 
pains  of  intercostal  neuralgia  may  be  thus  inhibited  by  continuous  pres- 
sure.   Pressure  is  of  great  value  in  spondylodiagnosis.    At  one  time,  cer- 
tain itinerant  physicians  won  great  renown  in  diagnosis,  by  eliciting  ten- 
derness in  definite  vertebral  regions  based  on  a  chart  published  by  Dr. 
Sherwood  in  1841.     In  1834,  the  Griffin  brothers,  English  physicians  of 

107 


Progressive     Spondylotherapy 

prominence,  sought  to  popularize  vertebral  tenderness  as.  a  diagnostic  aid. 
My  investigations,  and  a  synopsis  of  the  same  is  presented : 


Disease 


Points  of  greatest  tenderness 


Appendicitis  

Bladder,  rectum,  and  anus. 
Cholecystitis  

Gastric  disease  


Heart  Disease  

Ovarian  Disease  . 
Renal   Affections 


Tubal  Disease  ... 
Uterine   Disease 


8th  or  9th  dorsal,  or  2nd  lumbar,  right  side. 

1st  to  3rd  sacral   (both  sides). 

10th  and  llth  dorsal   (right  side)   and  tip 
of  llth  rib. 

4th  to  7th  dorsal  spines  painful  on  pres- 
sure when  lesion  (like  an  ulcer)  is  located 
on  lesser  curvature  between  cardia  and 
pylorus.  At  spine  or  side  of  10th  dor- 
sal, lesion  of  the  fundus.  From  10th  to 
12th  dorsal,  lesion  is  at  greater  curva- 
ture close  to  pylorus. 

3rd  to  6th  dorsal,  left  side. 

3rd  lumbar,  on  side  of  disease. 

10th    to    12th    dorsal    spines    on    side    of 
disease. 

At  or  below  3rd  lumbar,  on  affected  side. 

4th  lumbar  spine. 


Spondylodiagnosis. — (1)  Electric  current  or  persistent  friction  o*f  the 
skin  over  tender  area  causes  a  red  spot  to  appear.  (2)  Absence  of  typical 
painful  points.  (3)  Accentuation  of  vertebral  tenderness  by  manipula- 
tion of  the  suspected  viscus.  (4)  Elicitation  of  dermatomes.  (5)  Segmental 
analgesia  of  the  viscera.  (6)  Tenderness  is  superficial  and  if  the  skin  is 
pushed  to  one  side,  deep  pressure  causes  little  pain.  (7)  Unlike  tender- 
ness of  a  spinal  neuralgia,  rubbing  the  part  does  not  provoke  a  localized 
spasm  of  muscle.  (8)  In  tenderness  of  visceral  origin,  there  is  no  de- 
formity nor  rigidity  of  the  vertebral  column  and  movements  are,  as  a 
rule,  painless. 

In  a  large  number  of  cas-es  examined  by  Dr.  George  Jarvis,  with  rela- 
tion to  vertebral  tenderness  in  visceral  disease  based  on  the  foregoing 
table  and  corroborated  surgically,  the  following  conclusions  are  formu- 
lated; (1)  In  no  case  would  conclusions  based  on  the  spondylodiagnosis 
have  led  one  astray  as  to  the  organ  involved;  (2)  Spondylodiagnosis  alone 
does  not  usually  yield  a  complete  pathological  diagnosis ;  but  it  does  accu- 
rately point  out  which  organ  is  involved  and,  in  connection  with  other 
"clinical  findings,"  permits  of  the  greatest  accuracy. 

4.  Freezing. — In  the  treatment  of  localized  areas  of  vertebral  tender- 
ness, nothing  in  the  experience  of  the  writer  exceeds  cold  as  a  remedial 

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Review    of    S  p  o  n  d  y  1  o  t  h  e  r  a  p  y 


measure.    The  technique  of  psychrotherapy  is  fully  described  in  my  work 
on  Spondylotherapy. 

In  trigeminal  neuralgia,  freezing  is  executed  over  the  site  of  the  Gas- 
serian  ganglion  and  over  the  two  upper  cervical  vertebrae.  Jarvis  and 
Endelman,  observe  that  for  promptness  and  efficiency,  freezing  is  sur- 
passed by  no  other  therapeutic  or  operative  method  in  the  treatment  of 
pain  of  dental  origin,  or  any  structure  of  the  face  innervated  by  the 
trigeminus.  In  postextraction  pain,  it  is  magical.  Their  conclusions  are 
based  on  a  series  of  200  cases  of  trigeminal  pain. 

Comparison  of  Methods. — It  is  only  possible  in -a  general  way  to  say 
what  is  the  most  efficient  method  for  eliciting  the  visceral  reflexes.  Like 
all  cells,  the  neurones  do  not  react  to  the  same  stimulus.  Weak  stimulation 
as  a  rule  increases,  and  strong  stimulation  decreases  the  activity  of  the 
cells. 

Unfortunately  few  physicians  are  sufficiently  skilled  in  physical  diagno- 
sis to  determine  for  themselves  the  amplitude  and  duration  of  the  visceral 
reflexes.  Thus,  in  a  patient  with  an  aortic  aneurysm,  the  following  com- 
parative results  were  obtained  in  eliciting  the  aortic  reflex  of  contraction: 


Method 

Duration   of  treatment 

Duration  of  reflex 

Concussion    

1  minute  to  7th  cervi- 

12 minutes. 

Rapid    sinusoidal   cur- 
rent      - 

cal  spine. 
1  minute  to  both  sides 
of  same  spine. 

36  minutes. 

Take  again  the  normal  stomach  reflex  of  contraction  and  we  have  the 
following  results: 


Method 

Duration   of   treatment 

Duration  of  reflex 

Slow  blows  directly  to 
spinous  process  
Slow  blows  to  'both 
sides  of  spinous  pro- 
cess     

One-half  minute. 
One-half  minute. 

3  min.,  35  sec. 
16  minutes. 

Slow  sinusoidal  cur- 
rent to  both  sides,  of 
spine       

One-half  minute. 

8  minutes. 

The  vasodilator  lung  reflex  employed  by  the  writer  in  pufmonary  tuber- 
culosis may  likewise  be  cited.  The  duration  of  the  reflex  refers  to  the 
duration  of  dulness  and  the  stimulus  is  applied  to  the  tenth  dorsal  spine. 

109 


Progressive     Spondylotherapy 


Method 

Duration   of  treatment 

Duration  of  reflex 

Concussion  

1  minute. 

45  seconds. 

Rapid  sinusoidal  current 
Slow  sinusoidal  current- 
High-frequency   current.. 
Paravertebral    pressure- 

1  minute. 
1  minute. 
1  minute. 
1  minute. 

6  minutes. 
No  result. 
4  min.,  10  sec. 
10  minutes. 

When  pressure  exceeded  one  minute.,  the  dullness  was  of  short  dura- 
tion. 

The  reflexes  are  more  easily  exhausted  by  pressure  than  by  any  other 
method. 

For  discharging  visceral  reflexes,  the  rapid  sinusoidal  current  is  always 
more  efficient  than  the  slow  current.  With  different  sinusoidal  machines 
one  secures  discordant  results. 

Pharmacological  Methods. — Insomuch  as  adrenalin  acts  exclusively  on 
the  sympathetic,  and  pilocarpine  on  the  autonomic  fibers,  these  drugs  are 
used  by  the  writer  as  synergists  to  augment  the  amplitude  of  the  visceral 
reflexes. 

Physiology  of  Spondylotherapeutic  Methods. — 'Physiologists  are  not 
in  accord  whether  the  spinal  cord,  like  the  peripheral  nerves,  reacts  direct- 
ly to  stimuli.  The  clinician,  however,  has  evidence  to  show  that  the  spinal 
cord  is  excitable  to  direct  stimulation. 

Experiments  show  that  most  nerve  cells  discharge  their  motor  impulses 
at  a  rate  of  albout  ten  per  second  and  if  these  cells  are  stimulated  arti- 
ficially the  motor  discharge  is  aibout  the  same  rate  as  the  normal.  This 
reaction  of  the  nerve  cells  is  endowed  with  a  definite  rhythm  which  has 
been  compared  with  the  rhythmical  beat  of  the  heart.  (At  a  meeting  of 
the  American  Association  for  the  Study  of  Spondylotherapy  on  Sept.  20, 
1916,  Planck  exhibited  a  sinusoidal  apparatus  connected  with  a  compress- 
ing armlet,  thus  enabling  the  current  to  be  delivered  rhythmically  with 
each  beat  of  the  patient's  heart.) 

Concussion. — 'This,  is  a  mechanical  stimulus  and  is  equivalent  to  a  blow, 
pressure,  pinching,  or  section.  Concussion  of  short  duration  augments  the 
excitability  of  the  spinal  segments  or  nerves,  but  when  prolonged  the 
excitability  is  diminished  or  abolished. 

Sinusoidalisation. — This  is  the  equivalent  of  an  electric  stimulus.  The 
rapid  sinusoidal  current  is  stimulating,  whereas  the  slow  sinusoidal  cur- 
rent yields  a  series  of  electric  shocks.  In  the  application  of  the  latter  cur- 
rent to  the  spine,  motor  effects  are  only  exceptionally  observed,  the  action 
being  limited  to  subduing  the  sensory  component  of  a  spinal  segment. 

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Pressure. — This,  when  executed  upon  a  mixed  nerve,  paralyzes  the 
motor  earlier  than  the  sensory  fibers.  If  the  pressure  is  applied  gradually, 
the  nerve  may  be  rendered  inexcitable  without  demonstrating  any  evidence 
of  its  'being  stimulated.  Pressure  on  a  mixed  nerve  extinguishes  reflex 
conduction  sooner  than  motor  conduction. 

Freezing. — 'Notwithstanding  a  series  of  histological  examinations  made 
by  myself  to  explain  the  rationale  of  this  method  as  a  remedial  agent,  no 
definite  conclusion  was  attained.  The  leucocytic  infiltration  of  the  tissues 
which  followed  the  freezing  may  possibly  implicate  the  process  of  phago- 
cytosis which  in  turn  would  suggest  the  infectious  nature  of  many  neu- 
ralgias in  which  affections,  owing  to  the  rapidity  of  action,  freezing  may 
be  regarded  almost  as  a  specific.  The  initial  contraction  of  the  vessels 
and  tissues  is  followed  iby  a  greater  dilatation  and  turgescence.  When  the 
temperature  is  sufficiently  low,  the  excita/bility  of  all  the  nerves  is  dimin- 
ished, 'but  the  limited  duration  of  the  reduced  temperature  in  psychro- 
therapy  excludes  this  factor. 

THERAPEUTICS  OF  THE  REFLEXES. — Heart  Reflex. — Attention  was  first  di- 
rected in  1898,  to  the  phenomenon  now  known  as  the  heart  reflex  of 
Abrams.6  This  reflex  which  is  easily  demonstrated  by  percussion  and  the 
x-rays,  has  .been  confirmed  'by  Zulawski,  in  Germany,  Merklen  and  Heitz? 
in  France,  Sir  James  Barr  and  Sir  Thomas  Allbutt  in  England,  and  by 
notable  investigators  elsewhere. 

In  a  communication  iby  Cohen  (May  24,  1915)  to  the  College  of  Physi- 
cians, Philadelphia,  forty-three  illustrations  were  presented  demonstrat- 
ing the  effects  of  concussion  of  the  seventh  cervical  spine  on  the  heart 
and  aorta.  He  comments!,  "One  of  the  phenomena  that  has  been  neglected 
by  many  who  might  be  supposed  to  seek  every  means  at  their  command 
to  help  those  who  come  to  them  for  relief  is  the  heart  reflex  of  Abrams." 
The  reflex  in  question  is  a  contraction  of  the  myocardium  of  short  dura- 
tion in  health  (longer  duration  in  myocarditis)  and  attains  its  greatest 
amplitude  and  duration  iby  stimulation  (usually  concussion)  of  the  sev- 
enth cervical  spine.  The  heart  reflex  of  contraction  is  of  great  diagnostic 
value.  The  murmurs  in  relative  valvular  insufficiency  may  be  made  to 
disappear  temporarily  by  concussion  of  the  seventh  cervical  spine  which, 
by  causing  myocardial  contraction,  reduces  the  size  of  the  cardiac  orifices, 
thus.  enabling  the  valves  to  close  the  ostia. 

In  many  instances,  even  in  the  norm,  concussion  of  the  seventh  cervical 
spine  may  elicit  a  systolic  murmur  varying  in  duration  from  one-half  to 
three  minutes.  The  duration  of  a  normal  heart  reflex  is  approximately  two 
minutes;  in  myocardial  disease  it  may  persist  for  several  hours.  In  the 
treatment  of  cardiac  insufficiency,  elicitation  of  the  heart  reflex,  yields 
immediate  results  or  none  at  all.  My  experience  with  this  reflex  in  car- 

111 


Progressive     Spondylotherapy 

diopaths  enables  me  to  conclude  that  if  in  its  elicitation  no  results  are 
achieved,  very  little  may  be  anticipated  from  cardiotonic  medication. 

The  reflex  just  described  is  that  of  contraction  but  there  is  counter- 
reflex,  known  as  the  heart  reflex  of  dilatation,  superinduced  by  concus- 
sion of  the  ninth  to  the  twelfth  dorsal  vertebrae,  or  better  still  by  con- 
cussion between  the  third  and  fourth  dorsal  spines. 

Minerbi,  at  the  University  of  Rome,  finds  a  prompt  retraction  of  the 
sound  heart  when  the  precordial  region  is  tapped,  the  retraction  in  normal 
persons  amounted  to  a  total  of  4  cm.  for  the  entire  heart  in  the  course  of 
3  minutes.  The  retraction  is  due  to  the  autonomic  excitability  of  the 
muscle  tissue  independent  of  the  diastole  proper.  By  aid  of  the  heart  re- 
flex, he  learned  that  the  auricle  and  the  atrium  can  contract  independently 
of  each  other  as  well  as  of  the  ventricle. 

Angina  Pectoris. — In  the  form  of  this  affection  which  I  have  called  the 
cardiectatic  variety  dependent  on  cardiectasia,  immediate  relief  frequently 
follows  elicitation  of  the  heart  reflex  of  contraction  but  in  the  conventional 
variety,  this  reflex  will  accentuate  the  symptoms.  In  the  latter  variety,  one 
may  achieve  results  by  evoking  the  heart  reflex  of  dilatation. 

Bitfield  (/.  A.  M.  A.,  Feb.  3,  1917),  inhibits  the  pains  of  false  angina  by 
having  the  patient  thrust  the  little  finger  firmly  into  the  external  auditory 
meatus.  This  maneuver  stimulates  the  aural  'branch  of  the  vagus  which, 
indirectly  elicits  the  heart  reflex.  Concussion  is  the  more  effective  method 
as  I  have  shown  in  "Physico-Clinical  Medicine  (March  1917,  p.  78.)  I 
have  noted  that  some  patients  will  intuitively  suppress  an  attack  by  pres- 
sure on  the  eyeball.  They  excite  the  oculocardiac  reflex.  In  the  norm, 
pressure  on  the  eyeball  slows  the  pulse  through  vagus  inhibition.  An  ac- 
celeration or  retardation  of  10  beats  or  more  a  minute  is  abnormal.  The 
reflex  arc  of  this  phenomenon  consists  of  afferent  impulses  by  the  ophthal- 
mic branch  of  the  5th  nerve  to  the  nuclear  cells  of  origin  of  the  vagi  in  the 
4th  ventricle. 

When  one  irritates  the  nasal  mucosa  by  various  inhalations,  etc.,  the 
heart  reflex  of  contraction  ensues.  The  value  of  amyl  nitrite  inhalations 
in  the  treatment  of  angina  pectoris  is  universally  conceded,  ibut  when  this 
drug  fails  to  bring  relief,  the  failure  may  be  attributed  to  irritation  of  the 
nasal  mucosa  which,  by  inducing  the  heart  reflex  of  contraction,  still  fur- 
ther accentuates  the  paroxysm.  In  such  instances  and,  in  fact,  in  nearly 
all  instances,  the  action  of  amyl  nitrite  is  aided  by  previous  cocainization 
of  the  nasal  mucosa,  which  eliminates  the  irritant  factor  of  the  inhalations. 

Functional  Cardiac  Neuroses. — These,  if  they  are  dependent  on  vagus 
hyptonia,  are  often  amenable  to  treatment  by  concussion  of  the  seventh 
cervical  spine  which  acts  by  stimulating  the  vagus.  If  the  neuroses  are 
dependent  on  vagus  hypertonia,  equally  good  results  may  ibe  achieved  by 
stimulating  the  depressor  nerve.  The  writer  has  empirically  established  the 

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Review    of    S  p  o  n  d  y  1  o  t  h  e  r  a  p  y 

fact  that  stimulation  of  the  latter  is  best  effected  between  the  third  and 
fourth  dorsal  spines. 

It  is  known  that  some  functional  forms  of  arrhythmia  may  arise  from 
vagus  stimulation,  which  not  only  shows  the  heart  rate,  but  may  also 
create  irregularities  in  rhythm.  By  eliminating  this  vagus  influence  by  the 
atropine  test,8  the  irregularities  will  disappear  thus  demonstrating  the  neu- 
rogenic  character  of  the  arrhythmia  or  bradycardia.  This  test  may  be 
eliminated  by  pressure  for  one-half  minute  between  the  third  and  fourth 
dorsal  spines  which  maneuver,  like  atropine,  depresses  the  vagus  action. 

Hypertension. — Tn  1904,  I  directed  attention9  to  the  fact  that,  hyperten- 
sion is  often  a  condition  which  is  desirable  and  not  to  be  opposed,  inso- 
much as  the  vasoconstriction  may  compensate  a  failing  heart.  This  view- 
point has  since  then  been  conceded.  In  such  instances,  vasoconstrictors 
are  injurious  and  the  correct  course  to  pursue  is  to  strengthen  the  heart 
and  the  blood-pressure  will  fall  of  its  own  accord.  A  single  seance  of 
concussion  of  the  spinous  process  of  the  seventh  cervical  vertebra  will  at 
once  reduce  the  pressure  provided  it  is  due  to  cardiac  enfeeblement. 
When  there  is  no  cardiac  enfeeblement,  pressure  may  often  be  reduced 
by  concussion  between  the  third  and  fourth  dorsal  spines.  At  the  latter 
point  we  stimulate  the  depressor  nerve.  If,  coincident  with  this  stimu- 
lation, percussion  of  the  lower  abdomen  is  executed,  areas  of  dullness 
caused  by  dilatation  of  the  splanchnic  vessels  may  'be  elicited.  The  physi- 
ologist knows  that  stimulation  of  any  centripetal  nerve  augments  blood- 
pressure  and  the  essential  factor  in  this  reflex  rise  is  vasoconstriction  of 
the  splanchnic  area.  The  only  exception  to  the  foregoing  rule,  is  stimula- 
tion of  the  depressor  nerve,  which  lowers  pressure  by  dilating  the  splanch- 
nic vessels. 

The  Splanchnic  Circulation. — Many  factors  are  concerned  in  hyperten- 
sion but  the  splanchnic  vessels  are  practically  ignored.  The  latter  have 
the  greatest  effect  on  blood-pressure  and  the  vessels  in  question  are  suffi- 
ciently capacious  to  hold  practically  the  entire  •bloodvolume  of  the  body. 

It  is  many  years  since  I  first  directed  attention  to  the  splanchnic  circu- 
lation. 1°  Since  then,  many  writers  have  added  to  the  literature  on  the 
subject,  notably,  Robt.  T.  Morris,11  and  more  recently,  A.  B.  Hirsch,  in  a 
communication  to  the  College  of  Physicians  of  Philadelphia  on  Jan.  25, 
1915. 

The  splanchnic  circulation  may  cause  hypertension  or  hypotension,  more 
frequently  the  latter.  In  the  former  instance,  cardioptosis  is  nearly  always 
associated  with  a  defective  splanchnic  vasomotor  mechanism  which  causes 
cardiac  enfeeblement,  and  to  compensate  the  latter  there  is  a  constriction 
of  the  vasomotors  which  causes  hypertension.  In  such  instances,  a  forcible 
lifting  of  the  abdomen  during  the  time  ibloodpressure  is  taken  will  cause 
a  fall  in  pressure.  If  hypotension  is  present,  the  latter  maneuver  wiM 
cause  the  pressure  to  rise. 

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Progressive    Spondylotherapy 

Sir  James  Barr,  England's  master  clinician,  referring  to  "Cardiac  In- 
sufficiency" (British  Med.  Jour.,  April  15,  1916),  refers  several  of  its 
symptoms  to  a  gravitation  of  blood  into  the  abdominal  cavity.  "These 
phenomena,"  he  continues,  "have  been  aptly  termed  Cardio-Splanchnic  pa- 
resiS  by  Albert  Albrams  and  an  abdominal  belt  worn  tightly  does  good." 

Constriction  of  the  splanchnic  vessels  may  be  attained  by  concussion  of 
the  fifth,  sixth  and  seventh  dorsal  spines,  whereas  stimulation  of  the  de- 
pressor nerve  will  cause  the  converse  condition". 

Aneurysm — Since  the  writer  reported  12,  13  forty  cases  in  his  own  prac- 
tice of  thoracic  and  abdominal  aneurysm  symptomatically  cured,  the 
"Abrams  method,"  has  been  extensively  employed  toy  others*  in  this  country 
whose  reports  may  be  found  in  the  literature.  No  other  adjuvant  meas- 
ure, not  even  rest,  was  employed.  Snow's  contribution3  is  specially  in- 
teresting insomuch  as  a  series  of  radiograms  are  shown  illustrating  varia- 
tions in  volume  of  aneurysms  superinduced  by  elicitation  of  the  aortic  re- 
flex of  contraction  (concussion  seventh  cervical  spine.)  The  Minerbis,  of 
Italy,  Houlie,  in  France,  and  other  foreign  writers  have  contributed  to  the 
literature  on  the  subject. 

After  the  lapse  of  years,  the  enthusiasm  of  my  early  reports  has  been 
modified  by  conservatism  which  enables  me  now  to  conclude  that  in  early 
cases,  the  "Abrams  method"  is  practically  a  specific,  but  in  late  cases*  all 
that  can  be  achieved  is  a  relief  of  symptoms,  and  that  can  be  done  more 
rapidly  than  by  any  other  known  method. 

Exophthalmic  Goiter. — In  this  condition,  concussion  of  the  seventh  cer- 
vical spine  is  practically  a  specific.  Even  after  a  single  seance  of  concus- 
sion one  may  note  a  reduction  of  the  pulse  from  ten  to  thirty  beats  per 
minute,  and  likewise  a  diminution  in  the  size  of  the  struma.  From  many 
reports  of  physicians,  the  results  have  been  practically  uniform.  The  fol- 
lowing is  an  excerpt  of  a  letter  from  a  physician  who  has  successfully 
treated  many  cases :  "It  is  only  a  question  of  time  when  physicians  will 
and  must  recognize  your  specific  treatment,  and  when  it  will  be  regarded 
as  criminal  negligence  for  the  physician  to  invoke  surgery  before  giving 
your  method  a  trial." 

Respecting  the  rationale  of  the  method,  the  reader  is  referred  to  my 
work  on  Spondylotherapy  and  to  a  contribution  in  International  Clinics*, 
vol.  iv.,  22d  series,  p.  35. 

Goiter. — Among  many  letters  received  from  physicians  one  question  is 
paramount:  Will  concussion  of  the  seventh  cervical  spine  cure  simple 
forms  of  goiter?  The  reply  to  this  question  may  be  given  as>  follows:  In 
goiters  showing  vascularity  of  the  gland  (soft  and  tender  with  systolic 
blowing  or  pulsation)  there  is  some  chance  of  reduction,  but  when  there  is 
fibrosis  of  the  gland  no  results  can  be  expected.  Enlargement  of  the 
thyroid  is  frequently  a  compensatory  phenomenon  like  kidney  hypertrophy 

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Review    of    S  p  o  n  d  y  1  o  t  h  e  r  a  p  y 

tc  compensate  for  the  secretory  deficiency  of  its  fellow,  or  when  polycythe- 
mia  occurs  in  high  altitudes  to  make  the  -most  of  the  deficient  supply  of 
oxygen.  Similarly,  the  thyroid  enlarges  because  it  is  required  to  supply 
itself  with  iodine  conveyed  to  it  .by  the  blood.  Here  iodides  or  thyroid 
extract  if  given  early  prove  curative. 

Lung  Reflexes. — The  lung  reflexes  of  contraction  and  dilatation  may 
be  elicited  by  stimulation  of  definite  spinous  processes.  'G.  Auld,14  in  com- 
menting on  "The  Lung  Reflexes  of  Abrams,"  observes,  "it  was  not,  how- 
ever, until  recent  years  that  anything  like  a  satisfactory  demonstration  of 
the  presence  of  bronchodilator,  as  well  as  bronchoconstrictor  fibers  in  the 
vagus  was  made  by  Roy  and  Brown,  and  during  the  present  year  this 
seems  to  have  been  conclusively  established  'by  the  work  of  Dixon  and 
Brodie.  But  it  undoubtedly  stands  to  the  credit  of  Abrams,  to  have  prov- 
ed, at  least  seven  years  since,  'by  a  simple  clinical  observation  that  the 
vagus  must  contain  bronchodilator  as  well  as  bronchoconstrictor  fibers." 
"The  Clive  Riviere  Sign"  (The  London  Lancet,  Aug.  21,  1915)  is  based 
says  the  author,  "on  the  lung  reflex  of  contraction  originally  described  by 
Albert  Abrams.  It  is  impossible  to  refer  in  detail  to  the  value  of  the 
lung  reflexes  in  diagnosis  and  treatment  and  we  must  be  content  with  a 
consideration  of  the  author's  methods  of  treating  bronchial  asthma. 

Asthma. — The  author's  theory  of  asthma  has  been  discussed  elsewhere 
(iSpondylotherapy,  p.  309).  By  concussion  or  sinusoidalization  of  the 
fourth  and  fifth  cervical  spines,  one  may  elicit  the  lung  reflex  of  con- 
traction and  it  is  this  maneuver  which  is  employed  .by  the  writer  in  the 
treatment  of  essential  asthma.  This  method  may  also  be  used  to  arrest  a 
paroxysm.  While  my  results  are  comparatively  good,  they  do  not  tally 
with  the  enthusiastic  reports  from  others  who  employ  in  preference  the 
sinusoidal  current;  one  electrode  over  the  spines  of  the  fourth  and  fifth 
cervical  vertebrae  and  the  other  electrode  over  the  sacrum.  Perhaps  the 
climatic  conditions  in  San  Francisco  may  have  much  to  do  with  my  re- 
sults. Owing  to  the  enfeebletnent  of  the  bronchial  musculature  in  asthma 
some  time  may  elapse  before  results  are  achieved  and,  until  that  time  has 
arrived,  it  is  necessary  to  employ  a  palliative  for  the  relief  of  the  patient. 

Cardiac  Asthma. — This  may  be  confounded  with  bronchial  asthma  but 
concussion  of  the  seventh  cervical  spine  by  inducing  the  heart  reflex  of 
contraction  should  inhi'bit  the  paroxysm,  but  will  accentuate  it  if  of  bron- 
chial origin. 

Stomach  Reflexes.— 'The  stomach  reflex  or  contraction  elicited  by 
stimulation  of  the  spines  of  the  first  three  lumbar  vertebrae  is  of  un- 
doubted value  in  the  treatment  of  motor  insufficiency  of  the  stomach. 
Concussion  of  the  fifth  dorsal  spine  will  dilate  the  pylorus  (pylorui: 
reflex).  This  fact  has  'been  utilized  for  the  following  purposes:  (1)  To 

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Progressive    Spondylotherapy 

relieve  pylorospastn ;  (2)  to  facilitate  rapid  absorption  and  hasten  the 
elimination  of  nauseous  drugs  from  the  stomach;  (3)  to  eliminate  the 
action  of  the  gastric  juice  on  drugs  destined  for  action  on  the  intestinal 
tract;  (4)  in  the  treatment  of  gastric  affections;  (5)  to  aid  duodenal  in- 
tubation. 

In  my  method  of  duodenal  intubation,  the  ordinary  stomach  tube  will 
pass  directly  into  the  duodenum  during  the  time  pressure  is  made  at  the 
fifth  dorsal  spine.  Cardiospasm  may  be  overcome  by  sinusoidalization 
between  the  third  and  fourth  dorsal  spines. 

Dr.  H.  E.  MacDonald  (Los  Angeles)  comments  on  the  pylorus,  reflex 
as  follows :  "I  believe  that  Albrams'  pylorus  reflex  will  revolutionize 
gastroenterology.  I  have  cured  stomach  troubles  of  many  years  duration 
by  instructing  the  patient  to  drink  a  couple  of  glasses  of  water  3  or  4 
hours  after  eating.  Then  to  lie  on  the  right  side  while  a  member  of  the 
family  percusses  the  5th  dorsal  spine.  A  patient  practically  moribund 
from  inanition  (incontrollable  vomiting)  was  a'ble  to  retain  his  milk  when 
the  pylorus  reflex  was  elicited  immediately  after  ingestion  of  the  milk." 

He  further  observes,  "It  appears  to  me  that  we  should  worry  no  longer 
about  the  Vomiting  of  Pregnancy."  Dr.  W.  J.  Caesar  (Richmond,  Cal.,) 
has  made  many  observations  with  the  pylorus  reflex  in  the  latter  condition 
and  knows  of  no  simpler  or  more  efficient  method  in  the  treatment  of  this 
intractable  affection.  After  the  ingestion  of  food,  the  pylorus  reflex  is 
elicited  before  the  pregnant  woman  rises  (Medical  Record,  Nov.  24,  '17.) 

Intestinal  Reflexes. — That  of  contraction  (stimulation  of  first  three 
lumbar  spines)  is  utilized  in  the  treatment  of  atonic  constipation  and  the 
reflex  of  dilatation  (stimulation  of  eleventh  dorsal  spine)  in  spastic  con- 
stipation. Since  using  my  method  of  duodenal  intubation,  I  have  found 
that  stimulation  of  the  tenth  dorsal  spine  will  augment  the  pancreatic 
secretion.  The  pains  of  a  duodenal  ulcer  may  be  precipitated  by  opening 
the  pylorus  which  permits  of  the  passage  of  chyme.  Augmentation  of  the 
pancreatic  secretion  'by  the  method  cited  will  arrest  the  pains  of  a  duo- 
denal ulcer  as  such  maneuver  al'kalinizes  the  chyme. 

Authorities  are  practically  agreed  that  the  passage  of  a  tube  beyond 
the  sigmoid  flexure  is  impossible.  By  pressure  at  the  eleventh  dorsal 
spine  which  dilates  the  sigmoid  flexure,  colonic  intubation  is  possible. 

I  have  recently  investigated  the  action  of  vertdbral  concussion  on  the 
appendix  and  found  by  fluoroscopic  examination  (bismuth  subcarbonate 
previously  ingested)  that  concussion  of  the  tenth  dorsal  spine  empties  it 
and  that  concussion  of  the  first  lumbar  spine  will  dilate  it.  I  have  already 
utilized  the  foregoing  maneuver  with  excellent  results  in  several  cases 
of  chronic  appendicitis.  Like  observations  have  been  made  by  many  com- 
petent clinicians. 

Concussion  of  the  twelfth  dorsal  spine  contracts  the  cecum.     This  lat- 

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Review    of    Spondylotherapy 

ter  observation  is  of  importance  in  bearing  on  the  recent  observations  of 
Reed15  concerning  the  etiology  of  essential  epilepsy. 

Liver  Reflexes. — 'These  consist  of  contraction  and  dilatation  of  the 
organ.  The  former  is  utilized  in  the  treatment  of  hepatic  toxemia  and  is 
likewise  available  in  intestinal  autointoxication.  The  latter  is  available 
in  early  hepatic  cirrhosis.  Contraction  and  dilatation  of  the  gall-bladder 
may  be  attained  by  vertebral  stimulation  over  definite  spinous  processes. 

Splenic  Reflexes. — The  splenic  reflex  of  contraction  is  employed  in 
the  treatment  of  splenomegaly.  In  latent  malaria,  one  may  precipitate  a 
typical  paroxysm  by  discharging  the  splenic  reflex  of  contraction  (concus- 
sion of  the  second  lumbar  spine).  It  is  assumed  that  the  occurrence  of 
the  latter  is  due  to  the  mechanical  extrusion  into  the  circulation  of  the 
plasmodia  which  have  lodged  in  the  organ.  In  suspected  malaria,  one 
may  find  plasmodia  in  the  blood  after  inducing  the  splenic  reflex  of 
contraction  even  though  absent  before  this  maneuver  is  executed.  Con- 
cussion of  the  eleventh  dorsal  spine  enlarges  the  spleen. 

Examinations  of  the  blood  made  for  me  by  a  competent  hematologist 
(Alfred  Roncoveieri,  M.  D.)  developed  the  following:  (1)  Average  in- 
crease of  erythrocytes  after  concussion  of  the  eleventh  dorsal  spine  only, 
300,000;  (2)  average  percentage  increase  of  hemoglobin  after  concus- 
sion of  eleventh  dorsal  spine  only,  five  per  cent.;  (3)  average  increase  of 
leucocytes  after  concussion  of  second  lumbar  spine  only,  2800;  (4)  aver- 
age increase  of  red  cells  after  alternate  concussion  of  second  lumbar  and 
eleventh  dorsal  spines,  650,000;  (5)  average  increase  of  hemoglobin  after 
the  latter  (alternate  concussion),  ten  per  cent. 

The  ubiquity  of  syphilis,  emphasizes  the  dictum  of  Fournier — General 
pathology  should  ibe  made  a  mere  annex  to  syphilography. 

The  Wassermann  test  is  uninfluenced  by  this  reflex  of  contraction,  but 
not  so  with  the  Noguchi  reaction.  In  a  number  of  observations  thus  far 
made,*  I  may  safely  conclude  that  if  aibsent  it  may  be  present  after  evo- 
cation of  the  reflex.  If  previously  present  it  is  invariaibly  accentuated. 
After  the  'blood  is  removed  in  the  usual  way  by  a  trocar  the  latter  is  oc- 
cluded by  the  finger  and  after  concussing  the  second  lumbar  spine  for  one 
minute  a  second  specimen  oi  blood  is  allowed  to  flow.  Elsewhere,  I  have 
shown  that  in  malaria,  daily  elicitation  of  the  splenic  reflex  of  con- 
traction coupled  with  quinin,  is  the  most  efficient  treatment.  My  present 
investigations  in  syphilotherapy  show  like  results.  The  spleen  is  practi- 
cally a  "dead  corner"  of  the  organism  and  the  usual  depository  for  the 
virus  of  all  infections.  Elicitation  of  the  splenic  reflex  hastens  the  ex- 
trusion into  the  circulation  of  virus  favoring  its  elimination  and  per- 
mitting its  more  certain  destruction  by  remedial  agents. 

*ABRAMS:  Medical  Record,  Oct.  6.  1917.  Frauchiger  (Physlco-Clin. 
Med.  Dec.  1917),  in  two  series  of  10  cases  each  taken  at  random  shows 
like  results. 

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Progressive     Spondylotherapy 

THERAPEUTICS  OF  MISCELLANEOUS  REFLEXES. — Gynecological.  —  The 
uterus  reflex  may  be  discharged  by  stimulation  of  the  first  three  lumbar 
spines.  Sinusoidalization  is  the  preferable  stimulus.  The  degree  of  uter- 
ine contraction  is  determinaible  by  palpation  or  directly  through  a  specu- 
lum. An  anemia  of  the  uterus  accompanies  the  contraction  and  eleva- 
tion of  the  ovaries.  Chas.  L.  Ireland,  M.  D.,  comments  as  follows:  "I  will 
say  that  up  to  one  year  ago  I  had  always  contended  that  when  an  ovary 
was  prolapsed,  surgery  was  the  only  recourse  and  I  had  good  reasons  for 
so  thinking.  By  the  use  of  the  sinusoidal  current  to  provoke  the  uterus 
reflex,  absolute  cure  resulted  in  nine  cases,  i.  e.  reposition  of  the  ovaries 
ensued."  In  a  later  communication  Ireland  prefers  stimulation  of  the 
tenth,  eleventh,  and  twelfth  dorsal  vertebrae  for  the  reduction  of  pro- 
lapsed ovaries. 

Dislocated  uteri  without  adhesions  are  amenaible  to  the  same  treatment. 

Uterine  hemorrhage,  relaxed  vagina,  and  rectocele  are  amenable  to 
treatment  by  spondylotherapy. 

In- agalorrhea,  concussion  or  sinusoidalization  of  the  third  and  fourth 
dorsal  spines,  will,  after  three  or  four  treatments  stimulate  the  mam- 
mary glands  to  normal  activity. 

^Several  of  my  students  engaged  in  obstetrical  practice  contend  that 
during  labor,  one  may  demonstrate  paravertebral  points  of  tenderness 
corresponding  to  the  lumbar  vertebrae  and  that  pressure  over  these  areas 
will  in  most  instances  either  mitigate  or  arrest  the  pains  and  thus  con- 
tribute to  painless  labor. 

Dr.  D.  V.  Ireland  contends  that  by  concussion  of  the  twelfth  dorsal 
spine  he  has  in  several  instances  restored  a  movable  kidney  to  its  normal 
position. 

Vasomotor  Reflexes. — Vasoconstriction  of  the  blood-vessels  is  best 
attained  by  stimulation  of  the  seventh  cervical  spine  and  vasodilation,  by 
stimulation  at  the  tenth  dorsal  spine.  These  effects  may  be  observed  with 
the  ophthalmoscope  and  bronchoscope.  In  one  case  seen  with  Marie,  in 
Paris,  in  an  individual  with  a  defect  in  the  cranium,  contraction  of  the 
meningeal  vessels  could  be  directly  observed  during  concussion  of  the 
seventh  cervical  spine. 

The  vasomotor  reflex  of  contraction  has  been  utilized  in  various  ways, 
notably  in  the  control  of  hemoptysis  (sinusoidalization),  migraine  (angio- 
paralytic  form),  urticaria,  etc.  Thus,  Dr.  Myer  Solis-Cohen  refers  to  the 
instantaneous  relief  secured  by  concussion  of  the  seventh  cervical  spine 
in  a  severe  case  of  urticaria  following  the  use  of  diphtheria  antitoxin; 
itching  and  rash  quickly  evanesced.  Cohen  used  the  same  method  of 
treatment  successfully  in  a  rebellious  case  of  migraine. 

Dr.  Hugo  Summa  and  Louis  Schrei/ber  recently  presented  before  the 
Ophthalmic  Society  of  St.  Louis  a  patient  with  corneal  ulcers  of  many 
years'  duration  which  had  resisted  treatment  by  many  competent  oculists. 

118 


Review    of    S p o n d y 1 o t h e r apy 

Acting  on  the  theory  that,  by  provoking  the  vasomotor  reflex  of  contrac- 
tion, not  only  would  contraction  of  the  vessels  ensue  but  likewise  aug- 
mented tone,  concussion  of  the  seventh  cervical  spine  (seances  daily)  re- 
sulted in  cure  within  one  week. 

Bladder  Reflex. — Contraction  of  the  wall  of  the  bladder  and  its  sphinc- 
ter may  be  observed  with  the  cystoscope  when  stimulation  of  the  fifth 
lumbar  spine  is  executed.  The  bladder  reflex  may  be  utilized  in  atonic 
conditions  of  the  bladder  misculature. 

Prostate  Reflex. — Stimulation  of  the  twelfth  dorsal  spine  with  a  strong 
rapid  sinusoidal  current  causes  a  reduction  in  the  size  of  the  prostate.  With 
the  finger  palpating  the  gland  during  the  action  of  the  current  with  an  in- 
terrupting electrode,  this  effect  may  be  observed  provided  the  stage  of 
active  parenchymatous  and  muscular  hyperplasia  has  not  been  succeeded 
by  an  overgrowth  of  fibrous  tissue.  Results  in  treatment  (provided  the 
latter  is  not  present)  are  immediate,  irrespective  of  the  stage  of  pros*- 
tatism. 

Thymus  Reflex. — This  has  been  utilized  by  the  writer  in  the  treatment 
of  pertussis,  and  the  reflex  is  invoked  by  concussion  of  the  seventh  cer- 
vical spine.  According  to  numerous  reports  received  from  physicians 
throughout  the  United  States,  this  method  of  treatment  has  arrested  the 
paroxysms  in  from  three  to  seven  days.  In  the  latter  reference,  the  sub- 
sternal  dullness  noted  by  me  in  pertussis  was  ascribed  to  an  aortectasia 
but  since  the  writer's  method  of  defining  the  thymus  gland  has  been  per- 
fected,2 the  paroxysms  of  pertussis  are  referred  to  hypertrophy  of  this 
structure. 

Paralysis  Agitans. — Parathyroid  insufficiency  is  the  most  recent  accept- 
ed theory  concerning  the  etiology  of  this  affection.  By  my  methods  of 
electronic  diagnosis,  one  may  measure  the  intensity  of  energy  emanating 
from  the  parathyroid  glands  and  my  investigations,  show  that  concussion 
of  the  6th  cervical  spine  will  augment  the  functional  activity  of  the  para- 
thyroids. 

REFERENCES 

1.  Taylor:  "An  appreciation  of  the  teachings  of  Dr.  Abrams;"  Cyclo- 
pedia and   Medical    Bulletin,    July,    1913. 

2.  Abrams:  New  Concepts  in  Diagnosis  and  Treatment,   1916. 

3.  Snow:  International  Clinics,  vol.  iv.,  23d  series,  1913. 

4.  Abrams:  Chart  of  Spondylotherapy. 

5.  Jarvis  and  Endelman:  Pacific  Dental  Gazette,  Dec.,  1913. 

6.  Abrams:   Medical  Record,   March   26,   1898. 

7.  Merklen  and  Heitz:  Examen  et   S6meitoque  du  Coeur. 

8.  Abrams:   Diagnostic  Therapeutics,   Rebman  Co.,   p.   300. 

9.  Abrams:  Am.  Journal   of  the  Med.   Sciences,  November,    1904. 

10.  Abrams:    Splanchnic   Neurasthenia    (The    Blues),    E.    B.    Treat   and 
Co.,  New  York,  4th  edition. 

11.  Morris:   Archives   of  Diagnosis,   Jan.,   1913. 

12.  Abrams:    British   Medical   Journal,   July   8,    1911. 

13.  Abrams:   La  Presse    Mgdicale,    Oct.    4,    1911. 

14.  Auld:   Lancet,  Oct.   17,   1903. 

15.  Reed:  Journal  A.  M.  A.,  May  2.6,  1916. 

rip 


THE  ELECTRONIC  REACTIONS 
OF  ABRAMS* 

By 
ALBERT  ABRAMS,  A.M.,  M.D.,  LLD. 

San  Francisco,  Cal. 

PRELIMINARY 

Diagnosis  is  the  most  exalted  and  yet  the  most  difficult  task  of  the 
physician — Qui  bene  dignoscit,  bene  curat.  A  correct  diagnosis  in  many 
important  diseases  falls  below  50  per  cent,  in  recognition  and  in  some  be- 
low 25  per  cent.  This  is  because  medical  practice  is  only  50  per  cent,  effi- 
cient. Until  the  physician  can  weigh,  measure  and  express  his  knowledge 
in  numbers,  his  art  has  scarcely  attained  the  dignity  of  a  science. 

Physical  science,  by  reason  of  the  universality  of  its  laws,  dominates 
every  phase  of  medical  research  and  knowledge,  irrespective  of  its  source 
must  be  invoked  to  participate  in  the  development  of  our  art. 

Descartes,  a  philosopher  discovered  the  reflex;  Leonardo,  an  artist,  dis- 
covered the  function  of  the  heart;  Hales,  a  clergyman  discovered  arterial 
pressure ;  Leeuwenhoek,  a  "bedell"  discovered  the  capillary  circulation ; 
Wren,  an  architect,  discovered  intravenous  injection  and  Priestly,  a  clergy- 
man discovered  the  function  of  the  green  plant. 

The  human  must  not  be  segregated  as  something  apart  from  other  en- 
tities of  the  physical  universe.  There  is  only  one  physics,  one  chemistry 
and  one  mechanics  governing  animate  an  inanimate  phenomena,  and  the 
latter  must  be  studied  by  physico-chemical  methods.  Vital  phenomena 
are  dynamic  and  the  actions  of  organisms  should  be  regarded  as  pro- 
cesses and  not  as  structures.  All  vital  phenomena  are  subject  to  the  same 
laws  governing  the  cosmos.  Every  atom  is  a  microcosm  teeming  with 
Titanic  forces  and  our  scientific  conception  must  embody  hylozoism — all 
nature,  including  the  world  itself,  is  alive. 

Even  though  one  admits  a  special  vital  or  "biotic"  energy,  it  must  be 

*Reproduced,  with  additions,  from  International  Clinics  (Vol..  I,  27th 
series,  1917);  "A  quarterly  of  clinical  lectures  by  leading  members  of  the 
medical  profession  throughout  the  world."  In  the  previous  article  in  this 
book  (Spondylotherapy),  "Human  Energy,"  the  stomach  reflex  was  utiliz- 
ed but  owing  to  the  difficulty  encountered  in  its  elicitation,  the  splanch- 
nic reflexes  are  here  substituted.  This  subject  is  elaborated  in  detail  in 
the  author's  recent  book  "New  Concepts  in  Diagnosis  and  Treatment"  and 
all  progress  made  on  the  subject  is  incorporated  in  the  author's  Journal 
"Physico-Clinical  Medicine,"  Numbers  in  parentheses  refer  to  pages  in 
"New  Concepts  in  Diagnosis  and  Treatment,"  where  the  subject  is  more 
fully  elaborated.  When  "S"  precedes  the  number  it  refers  to  the  page 
IB  Spondylotherapy. 

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disregarded  except  when  converted  into  recognized  forms  of  chemical  or 
physical  energy  in  equivalent  amount.  All  problems  hi  medicine  not  in 
accord  with  the  progress  made  in  physical  science  are  doomed  to  perish. 

Successive  innovations  have  completely  altered  the  physiognomy  of 
medical  practice. 

The  doctrine  of  cells  and  protoplasm,  gave  a  decided  impetus  to  the 
formulation  of  modern  biology  and  pathology,  but  it  has  suffered  many 
vicissitudes  notably  that,  in  the  interpretation  of  vital  phenomena,  one 
must  look  deeper  than  simple  cell-structure  as  revealed  'by  the  micro- 
scope. In  this  sense  the  Zeitgeist  demands  an  abrogation  of  this  misalliance 
of  medicine  and  cytology.  The  cells  constitute  a  superstructure  guided  in 
their  acitvity  by  physico-chemical  forces'.  The  cell  is  only  the  micromor- 
phologic  unit  of  plant  and  animal  organization. 

The  universality  of  the  laws  of  physical  science  are  in  accordance  with 
the  accepted  electronic  theory  viz.,  that  the  ultimate  atomic  -divisibility  of 
matter  is  represented  by  the  electron  and  not  the  cell,  hence,  the  archaic 
cell-doctrine  must  be  superseded  by  the  electronic  theory  (3). 

THE  ELECTRONIC  THEORY* 

The  actual  nucleation  of  the  electron  theory  forty  years  ago  in  its  ex- 
planation of  matter  is  perhaps  the  greatest  contribution  ever  made  to 
scientific  knowledge.  . 

The  units  of  our  organism,  the  electrons,  are  charges  of  electricity. 
In  their  incessant  activity  they  produce  the  phenomenon  known  as  radia- 
tion. 

The  physicist  limits  the  latter  to  a  few  elements  simply  because  his  ap- 
paratus lacks  sensitivity.  It  can  be  demonstrated  by  aid  of  the  reflexes 
that  radiation  is  a  universal  property  of  matter. 

REFLEXES  OF  ABRAMS 

Every  phenomenon,  in  nature,  is  dependent  upon  matter  in  motion  or 
vibration,  and  energy  is  employed  to  designate  the  modes  of  motion  in  the 
universe.  All  matter  responds  to  stimuli,  and  is  known  as  irritability. 
In  investigating  the  physiological  physics  of  the  various  forms  of  energy, 
the  visceral  reflexes  of  the  author  which  are  physiologic  constants  are 
employed.  Energy  is  susceptible  of  exact  measurement  and  as  all  forms 
are  convertible  into  heat,  physicists  measure  it  as  such.  The  writer  meas- 
ures energy  by  his  reflexes. 

In  accepting  the  visceral  reflexes  as  the  ibasis  for  our  diagnostic  reac- 
tions, bioplasmic  matter  is  employed,  the  most  primitive  and  sensitive 

*Prof.  Thomson  (Cambridge,  England),  received  in  1916,  the  Nobel 
prize  for  his  theory  of  the  electrons.  Prof.  R.  A.  Millikan,  (University  of 
Chicago),  succeeded  in  isolating  and  weighing  electrons,  the  ultimate 
units  of  electricity  and  the  most  unthinkably  minute  particles  ev««- 
thought  of  by  man. 

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Electronic      Reactions 

substance  for  exhibiting  the  phenomena  of  energy.  The  physiologic 
mechanism  designated  as  a  reflex,  surpasses  in  its  sensitivity  any  apparatus 
yet  devised  by  human  ingenuity. 

The  lungs  antedated  the  bellows;  the  heart,  the  pump;  the  hand,  the 
lever;  and  the  eye,  the  photographic  camera.  Telephonic  and  telegraphic 
apparatus  duplicate,  mimetically,  what  has  always  been  done  by  the  nervous 
system,  and,  always  by  aid  of  the  same  energy. 

The  animal  machine  is  equipped,  by  its  sense  organs,  as  receivers  for 
practically  all  kinds  of  energy. 

Olfaction  (20)  surpasses,  in  sensitiveness,  the  most  impressible  scientific 
ins'truments  and  the  retina  is  approximately  3000  times  as  sensitive  as  the 
most  rapid  photographic  plate. 

In  the  author's  recent  work,  "New  Concepts  in  Diagnosis  and  Treat- 
ment," the  stomach  reflex  is  almost  exclusively  employed  for  the  detection 
of  energy,  but  owing  to  the  difficulty  encountered  by  others  in  its  elicita- 
tion,  it  is  here  substituted  by  other  reflexes.  Consideration  will,  at  this 
time  be  only  accorded  to  the  diagnosis  of  carcinoma,  syphilis  and  tuber- 
culosis. The  diagnosis  of  other  affections  are  and  have  been  reported  in 
the  writer's  Journal,  "Physico-Clinical  Medicine." 

SPLANCHNO-DIAGNOSIS* 

The  successful  employment  of  this  method  predicates  a  knowledge  of 
percussion,  which  not  only  means  the  delivery  of  blows  but  the  interpre- 
tation of  sounds- — differences  of  pitch  and  resonance.  The  method  is  no 
more  flamboyant  than  the  elicitation  of  dulness  over  a  consolidated  lung 
area,  and,  if  the  former  is  unrecognized,  I  doubt  the  physician's  ability  to 
interpret  the  latter. 

SPLANCH NO-VASCULAR  REACTIONS. — Strong  stimulation  of  the  depressor 
nerve  dilates  all  the  abdominal  vessels.  An  individual  nerve  hasi  different 
functions.  When  we  perceive  a  variety  of  colors,  it  is  due  to  definite 
vibratory  rates  conducted  by  specific  fibers  which  are  natural  detectors  of 
energy.  When  the  physiologist  stimulates  a  nerve  or  muscle,  the  total 
energy  (irrespective  of  wave  lengths)  is  employed.  When  the  depressor 
nerve  is  stimulated  by  the  radiant  energy  of  disease,  the  abdominal  vessels 
respond  by  vasodilation  in  specific  abdominal  areas  as  revealed  by  dulness 
on  percussion.  This  nerve  may  be  stimulated  between  the  third  and  fourth 
dorsal  spines.  The  latter  area  was  first  determined  empirically  and  later, 
by  animal  experimentation.  The  action  referred  to  is  not  unlike  that  in 
spectroscopy  by  which  composite  radiations'  are  analyzed. 

*There  are  other  splanchnic  and  pulmodiagnostic  reactions  discovered 
by  the  author. 

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Electronic      Reactions 

The  following  angiodiagnostic  reaction  is  easily  executed  :f 

Take  a  culture  of  tu'bercle  bacilli  and  direct  the  opening  of  the  tube 
(without  removal  of  the  cotton)  to  the  region  between  the  3rd  and  4th 
dorsal  spines  (depressor  nerve)  and  note  that  within  10  seconds,  flushing 
ensues  in  the  region  of  the  infraorbital  foramen  just  below  the  infra- 
orbital  ridge  (Fig.  15).  The  area  in  question  represents  a  streak.  Apply 


FIG.    15. — Site   of   vasomotor   phenomena   incident    to    the   employment  of 
cultures  of  the  tubercle  bacillus  and  pneumococcus. 

the  tube  to  the  1st  dorsal  spine  and  in  about  10  to  20  seconds  a  streak  of 
pallor  ensues.  The  latter  is  less  conspicuous  than  the  former.  The  face  of 
the  subject  should  be  directed  toward  the  light  and  the  observation  is  to 
be  made  during  the  time  an  assistant  directs  the  tube  to  the  definite  spinal 
areas.  It  is  a  bilateral  phenomenon  if  the  tube  is  directed  to  the  spinous 
processes,  but  is  unilateral  if  applied  to  either  side  of  the  specified  spinous 
process.  Pallor  and  flushing  are  more  diffused  in  individuals  with  the 
phthisical  habitus  if  used  for  the  test.  It  is  also  evocable  when  energy 
is  conducted  from  a  tuberculous  lung.  Like  phenomena  are  noted  with  a 
culture  of  the  pneumococcus. 

This  experiment  may  be  elaborated  to  cause  a  more  diffused  redness 
or  pallor  by  aid  of  a  conducting  cord  with  two  electrodes.  To  accentuate 
the  flushing,  fix  one  electrode  at  the  first  dorsal  spine  and  allow  the  other 
electrode  to  come  in  contact  with  a  grounded  metal  plate.  Conversely,  to 
accentuate  the  pallor,  fix  one  electrode  at  the  area  between  the  3rd  and 
4th  dorsal  spines  and  the  other  on  the  ground  plate.  'Grounding  is  execut- 

tWith  other  forms  of  pathological  energy,  reactions  invariably  occur 
in  definite  areas  of  the  ear  and  face  and  substantiate  the  rationale  and 
definite  localization  of  the  areas  in  splanchno-vascular  diagnosis.  (V4^e 
in  the  latter  part  of  this  contribution,  the  use  of  the  ear  of  a  white 
rabbit). 

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Electronic      Reactions 

ed  during  the  time  energy  from  the  culture  tube  is  applied  to  secure 
flushing  or  pallor. 

It  is  assumed  that  in  the  foregoing  experiments  and  the  assumption  is 
verified  by  the  results  that,  the  center  for  vasodilation  of  the  vessels  of 
the  face  is  between  the  3rd  and  4th  dorsal  vertebrae,  and  that  of  vaso- 
constriction,  at  the  1st  dorsal  spine.  In  the  norm,  both  centres  are  in 
equilibrium  and  the  vessels  are  maintained  at  a  definite  caliber.  When 
we  ground  the  area  of  vasodilation  (between  the  3rd  and  4th  dorsal  spines), 
the  energy  necessary  to  maintain  dilation  is  abstracted  and  the  other 
center  (vasoconstriction).  has  undiminished  play  and  pallor  is  accentuated 
.  when  the  culture  of  tubercle  bacilli  (energy)  is  directed  to- the  1st  dorsal 
spine.  The  converse  is  likewise  true  when  one  grounds  the  1st  dorsal 
spine. 

Dr.  George  O.  Jarvis,  who  confirmed  the  visceral  reflexes  of  Abrams, 
at  the  operating  table,  executed  several  investigations  during  laparotomies 
bearing  on  the  conveyance  of  energy  from  tuberculous  and  carcinomatous 
material  to  the  region  between  the  3rd  and  4th  dorsal  spines.  Within 
several  seconds  each  time  after  the  electrode  was  brought  in  apposition 
with  the  latter  area,  there  was  a  decided  vasodilatation  in  specific  intra- 
abdominal  areas.  This  observation  was  confirmed  by  Drs.  Parsons,  A.  W. 
Boslough  and  others. 

'In  experimental  work  on  animals,  the  writer  found  that  the  slightest 
augmentation  of  vascularity  of  the  stomach  or  intestines  caused  a  transi- 
tion of  the  percussion  note  from  tympanicity  to  dulness. 

METHOD. — A  healthy  person  (subject)  other  than  the  patient  is  used 
for  making  the  electronic  diagnosis.  Exceptionally,  the  patient  may  be 
used  (vide  autoelectronic  reactions  later).  The  reactions  are  alike  in 
both  sexes.  Select  a  subject  with  thin  abdominal  walls-  in  whom  a 
tympanitic  sound  is  demonstrable  over  the  entire  abdomen.  When  a  suit- 
able subject  is  found  (usually  a  boy),  he  may  be  used  daily  for  diag- 
nosis. The  subject  must  face  the  west  (standing).*  The  splanchno  re- 
flexes cannot  be  elicited  in  the  recumbent  posture.  The  subject  stands 
on  a  plate  of  aluminum  which  is  connected  by  an  insulated  wire  to  a 
faucet,  radiator  or  gas  fixture.  The  modern  combination  fixture  is  unsuit- 
able for  grounding  owing  to  its  insulation  near  the  ceiling. 

Percuss  and  mark  the  entire  lower  liver  border  of  the  subject  (anterior- 
ly). Select  an  ordinary  flexible  conducting  cord  of  copper  to  both  ends 
of  which  electrodes  are  atttached.  Aluminum  electrodes  are  most  effect- 
ive. An  assistant  or  the  patient  places  one  electrode  (receiving  elec- 
trode, R.  E.)  over  the  source  of  radiation  (energy)  and  the  other  is 

*When  an  intermediary  is  used  (subject)  or  when  reactions  are  elicited 
from  the  patient  (autoelectronoic  reactions)  both  must  stand  facing  the 
•west  in  such  a  way  that  the  body  is  parallel  with  the  earth's  axis.  Any 
deviation  from  this  position  will  abrogate  the  areas  of  dulness.  Owing  to 
the  magnetic  declination  one  must  conceive  the  earth's  axis  in  relation 
to  the  true  geographical  poles. 

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Electronic      Reactions 

placed  by  an  assistant  exactly  between  the  third  and  fourth  dorsal  spines 
of  the  subject.  Within  thirty  seconds,  a  specific  area  of  abdominal  dulness 
will  be  elicited  and  the  latter  persists  during  the  energy  flow.  The  dul- 
ness disappears  during  deep  inspiration  but  reappears  with  ordinary 
breathing  by  the  subject.  For  esthetic  reasons,  a  screen  may  be  placed 
between  the  subject  and  the  patient.  Until  the  necessary  skill  is  ac- 
quired, a  diagnosis  should  not  be  made.  Preliminary  practice  may  be  at- 
tempted with  cultures,  blood  and  tumors.  Thus,  a  culture  of  tubercle 


PIG.  16. — Method  of  conveying  energy  from  the  spine  (area  corres- 
ponding to  7th  thoracic  spine  usually  selected)  in  a  patient  with  sus- 
pected syphilis  to  the  vertebral  region  of  the  subject.  An  assistant  holds 
both  electrodes.  In  the  absence  of  an  assistant,  the  metallic  tips  of  the 
conducting  cords  (electrodes  removed)  may  be  attached  by  adhesive 
plaster  and  the  conducting  cord  may  be  connected  with  a  push  button 
for  making  or  breaking  the  circuit  which  may  be  controlled  by  the  hand 
or  foot  of  the  physician.  Note  that,  owing  to  the  high  frequency  and 
voltage  of  the  energy  unipolar  conduction  suffices.  To  secure  uniform 
results,  patient  and  subject  during  the  execution  of  the  tests  should 
face  the  west. 


bacilli  yields   the  same   reaction  as   tuberculosis   and  the   blood   from  a 
syphilitic  yields  a  reaction  similar  to  syphilis. 

Cultures  or  a  carcinomatous  growth  may  be  directed  to  the  vertebral 
area  cited  without  the  use  of  conducting  cords. 

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LOCATION  AND  MENSURATION  OF  DULL  AREAS*  (Fig.  17)) 

Location  Vertical    Transverse 

Diameter      Diameter 

Carcinoma — Left  hypochrondriac  region  just 
below  and  merging  into  lower 

liver  border.  4  cm.  9  cm. 

Syphilis. — Just   above   the  navel   extending  to 
either  side  of  the  median  abdom- 
inal  line.  6  cm.  5  cm. 
Tuberculosis. — Just  below  the  navel.                           3  cm.           5  cm. 

PRECAUTION — Do  not  permit  the  fingers  to  come  in  contact  with  the 
metal  of  the  electrodes  am!  direct  them  away  from  the  latter  as  in  hold- 
ing the  magnet  (Fig.  24). f  Colors  on  the  subject,  patient  or  in  the  room 
should  be  excluded.  Differences  in  percussion  sounds  (change  from  tym- 
panici'y  to  dulness)  may  surely  be  acquired  by  practice.  Exclude  the 
personal  eq  lation  in  percussion  by  having  contact  made  "with  the  R.  E. 
without  your  knowledge  and  note  if  you  can  tell  by  the  appearing  dulness 
when  this  is  done.  Short  conducting  cords  of  large  diameter  conduct 
more  energy  and  accentuate  the  areas  of  ventral  dulness;  the  resistance 
of  the  cord  depends  directly  upon  its  length  and  inversely  upon  its  sec- 
tion. When  the  energy  is  measured  by  the  rheostat  (Fig.  25),  uniform 
measurements  can  only  be  secured  by  cords  of  the  same  length  and 
section. 

Pressure  on  the  dorso-lumbar  spine  or  metasternum  during  percussion 
accentuates  ventral  dulness  (S80).  If  the  physician  places  his  foot  on  the 
ground  plate  during  percussion  dulness  is  accentuated.  Equally  effective 
is  the  execution  of  percussion  at  the  end  of  forcible  expiration.  The  elec- 
trode approximating  the  area  between  the  third  and  fourth  dosal  spines 
should  not  exceed  \l/2  inches  in  diameter.  In  denning  the  lower  liver 
border  and  the  splanchnic  reactions,  use  a  barely  audible  uniform  percus- 
sion blow  With  a  strong  blow  the  liver  border  will  be  found  lower  than 
with  a  light  blow,  and  the  intestinal  reflex  of  contraction  (S325)  also 
evoked  would  yield  a  dulness  which  would  be  misleading.  It  is  a  recog- 
nised law  of  sense  perception  that  the  less  loud  the  initial  sound,  the 
simpler  it  is  to  recognise  its  variations.  The  sense  of  greatly  increased 
resistance  is  associated  with  impaired  resonance. 

The  subject  must  directly  face  the  west;  many  reactions  cannot  be 
elicited  when  this  rule  is  violated. 

All  pathological  specimens  must  foe  removed  from  the  vicinity  of  the 
cords  and  electrodes  to  eliminate  their  possible  conduction. 

*Thcse  measurements  were  determined  in  a  man  used  as  a  subject.  If 
a  boy  is  used,  the  areas  would  be  less.  The  topography  of  the  areas 
may  vary  in  a  subject  with  splanchnoptosis,  but  they  may  always  be  pre- 
determined by  cultures  and  specimens. 

tTouching  the  conducting  cords  or  crossing  of  the  same  (in  using 
biodynamometer)  must  be  avoided  to  prevent  short-circuiting  of  the 
energy. 

126 


Electronic      Reactions 

A  subject  with  reddish  hair  must  not  be  selected.  If  colors  approxi- 
mating this  shade  are  placed  across  the  cranium  of  the  subject,  many 
reactions  cannot  be  elicited.  Short-circuiting  the  brain  (.109)  will  obviate 
the  foregoing  interference. 

Normal  energy  does  not  traverse  a  non-conductor  but  pathological 
energy  does.  Certain  areas  of  the  body  (72)  discharge  energy  in  the  norm 
and  the  polarity  of  the  latter  may  prevent  the  elicitation  of  the  splanch- 
nic reflex.  When  such  regions  are  encountered,  it  is  always  advisable  to 


FIG.  17. — Elicitation  of  ventral  areas  of  dulness  when  specific  patho- 
logical energy  is  conveyed  to  the  area  between  the  3d  and  4th  dorsal 
spines.  C,  cancer  area;  S,  syphilitic  area;  TB,  tuberculous  area.  The  in- 
tensity of  dulness  is  in  direct  proportion  to  the  potentiality  of  the  con- 
veyed pathologic  energy  and  thus  serves  as  an  index  to  the  severity  of 
the  disease. 

cover  the  electrode  in  contact  with  the  spine  (between  the  3rd  and  4th 
dorsal  spines)  with  thin  dental  rubber  dam  when  executing  the  tests. 

Always  note  the  percussion  note  over  the  abdomen  before  executing 
a  test,  for  owing  to  the  sudden  accumulation  of  gases  the  transition  of 
resonance  to  dulness  may  cause  a  misinterpretation  of  the  reaction. 

Do  not  exhaust  the  subject;  the  accumulation  of  blood  in  the  abdomen, 
an  attendant  of  enervation,  will  cause  ventral  areas  of  dulness. 

To  accentuate  the  areas  of  ventral  dulness  when  necessary,  connect  5th 

127 


Electronic      Reactions 

dorsal  spine  by  a  conducting  cord  to  the  ground  plate  on  which  the  subject 
stands  during  the  time  energy  is  conveyed  to  the  depressor  nerve.  The 
5th  dorsal  spine  corresponds  to  the  splanchnic  nerve  and  when  its  tone  is 
removed  by  grounding,  its  opposition  to  the  dilatation  of  the  splanchnic 
vessels  is  partially  removed. 

SYPHILIS. — In  this  disease  though  quiescent  and  in  any  stage  and  irre- 
spective of  treatment,  the  reaction  is  always  elicited  from  any  part  of  the 
spine,  liver  or  spleen.*  It  is  also  obtainable  over  any  active  luetic  lesion 
elsewhere.  With  the  electronic  reactions,  the  ubiquity  of  syphilis  can  be 
demonstrated  and  recalls  what  the  eminent  syphilographer,  Fournier  said 
of  it — General  pathology  should  be  made  a  mere  annex  to  syphilography. 
The  German  diagnostician  avers :  "Was  man  nicht  -diagnos<tieren  Kann. 
Sieht  man  als  n'syphilis  an." — (When  your  diagnosis  goes  amiss,  always 
think  of  syphilis.) 

The  recognized  serological  methods  are  discountenanced  as  is  evident 
from  the  following: 

"A  positive  Wassermann  unsupported  by  clinical  evidence  is  not  suf- 
ficient evidence  of  the  presence  of  syphilis."  (Keyes). 

"Errors  in  the  diagnosis  of  specific  diseases  of  the  nervous  system  were 
no  greater  in  the  pre-Wassermann  days  than  at  the  present  time." 
(Weisenburg). 

There  is  only  one  chance  in  five  that  a  specimen  of  iblood  submitted  to 
ten  serologists  will  result  in  an  agreement.  Collins  (A.  J.  M.  Sc.,  1916), 
estimates  that  15  per  cent  of  paretics  and  70  per  cent  of  cerebrospinal 
syphilitics  fail  to  give  a  positive  Wassermann  in  the  spinal  fluid. 

Abrams'  reactions  inform  one : 

1.  Whether  syphilis  is  present  or  absent. 

2.  If  present,  whether  it  is  congenital  or  acquired. 

3.  What  tissues  are  or  will  become  invaded  (vide  infra). 

4.  What  is  the  intensity  of  the  disease? 

CONGENITAL  SYPHILIS.  —  Differentiation  of  congenital  from  acquired 
syphilis  is  possible  by  the  following  test:  Place  the  R.  E.,  over  either 
closed  eye  of  the  patient  and  the  other  electrode  between  the  third  and 
fourth  dorsal  spines  of  the  subject.  In  congenital  syphilis  the  abdominal 
area  peculiar  to  syphilis  (Fig.  17)  appears  but  measures  in  its  transverse 
diameter  about  10  cm.,  in  lieu  of  5  cm.  (man  used  as  subject).  This  re- 
action isi  not  present  in  acquired  syphilis  in  the  absence  of  ocular  luetic 
lesions.f 

*The  spleen  in  the  norm  yields  a  pseudosyphilitic  reaction,  1.  «.,  it  pro- 
vokes the  reflexes  peculiar  to  syphilis.  Differentiation  is  possible  by 
recalling  that  it  will  not  produce  the  reflexes  at  the  vibratory  rate  of 
syphilis  (at  20)  but  at  its  own  vibratory  rate  (at  1  ohm);  its  poten- 
tiality is  rarely  in  excess  of  2/25  of  an  ohm  and  its  polarity  is  positive. 
As  a  rule,  in  syphilis,  one  elicits  the  reactions  from  the  radioactivity 
emanating  from  the  spine. 

tin  the  Kiel  eye  clinic,  the  optic  nerve  was  affected  in  two-thirds  of 
50  syphilitics. 

128 


Electronic      Reacti  on  s 

In  congenital  syphilis  only,  it. will  also  >be  noted  that  when  the  energy  is 
conveyed  from  the  spine  or  liver  of  the  patient,  there  is,  in  addition  to  the 
epigastric  area  of  dulness,  an  area  measuring  10  cm.  vertically  and  12cm. 
horizontally  beginning  midway  between  the  navel  and  the  symphysis  pubis 
and  extending  to  the  latter*  (Fig  18). 

It  is  now  known  that  there  are  distinct  strains  of  the  spirocheta;  with 
one  strain,  eye  lesions  in  rabbits  may  be  produced,  whereas  another  strain 
never  produces'  these  lesions.  Investigators  have  shown  that  syphilis  may 
affect  the  heart  alone  (spirocheta  present)  without  histological  lesions  or 


FIG.    18. — Site    of   additional    area    of    ventral    dulness    in    congenital 
syphilis  when  energy  is  conveyed  from  the  patient  to  the  subject. 

spirochetes  elsewhere.  In  a  considerable  percentage  of  newborn  infants, 
spirochetes  at  the  autopsy  have  been  found  in  the  aorta. 

Bacterial  localization  emphasizes  the  fact  that  there  must  be  a  great 
variety  of  species  or  sub-species  among  the  spirochetes  and  that  the 
elective  localization  of  lesions  is  dominated  by  this  facl.J 

In  addition  to  this  general  reaction,  there  are  specific  areas  of  dulness 

*The  subject's  bladder  must  be  empty  to  eliminate  the  impaired  reson- 
ance of  the  distended  viscus. 

{Specific  strains  in  tuberculosis  have  also  been  noted  by  the  author 
by  aid  of  his  reactions. 

129 


Electronic      Reactions 

which  seem  to  indicate  the  tissue  for  which  the  spirochetes  show  a 
predilection.  If  these  additional  areas  are  present,  either  the  structure 
is  already  invaded  or  its  invasion  may  'be  predicted  in  the  event  the 
luetic  proce&s  is  uninfluenced  by  treatment.  The  areas  thus  far  elicited 
are  shown  in  Figs.  19  and  20. 

Under   energetic   antiluetic   treatment,   the   reaction    from    the    frontal 
eminences  in  dementia  paralytica  (172)  may  disappear. 


FIG.  19. — Ventral  areas  of  dulness  in  syphilis  when  the  spinal  energy 
in  this  disease  is  conveyed  to  the  area  between  the  3rd  and  4th  dorsal 
spines.  A,  area  in  all  cases  of  syphilis  irrespective  of  the  special  struc- 
ture invaded.  In  addition  to  the  latter,  the  area  B,  is  present  in  cardio- 
vascular lesions;  C,  lesions  of  spinal  cord  and  nerve  roots;  D,  eye 
lesions;  E,  pulmonary  lesions. 

Fournier,  observed  that  98  per  cent  of  the  children  of  syphilitic  parents 
are  syphilitic.  The  electronic  reactions  show  that  they  are  all  syphilitic, 
The  tale  of  syphilitic  parents  may  be  inscribed  as  follows :  'Sterility,  Still- 
births, miscarriages,  abortions,  progeny  dying  in  infancy  of  marasmus, 
meningitis,  convulsions,  etc.  Familial  syphilis  is  suggestive  if  any  of 
the  following  diseases  have  occurred  among  relatives :  Tabes,  paresis, 
aneurysm,  apoplexy  (before  50  years  of  age),  cardiorenal  disease  (before 
50  or  55  years),  headaches  (not  relieved  by  the  usual  means),  nervous- 
ness (without  obvious  cause),  rheumatism  (obscure)  and  tuberculosis  in 
several  members  of  the  same  family,  'because  hereditary  syphilis  accord- 

130 


Electronic      Reactions 


FIG.  20. — Site  of  area  in  dementia  paralytica  from  energy  conducted 
from  the  spine  of  the  patient  to  the  subject.  This  site  was  determined 
from  a  study  of  three  luetics  who,  after  a  lapse  of  approximately,  two, 
three  and  four  years  developed  paresis.  This  site  is  also  present  in  de- 
veloped cases. 

ing  to  Fournier,  strongly  predisposes  to  tuberculous  infection  later  in  life. 
Congenital  syphilis  is  unfortunately  identified  with  its  manifestations  at 
birth  and  we  forget  that  it  may  not  develop  until  adolescence  or  late  in 
life  (syphilis  tarda).  I  wish  to  direct  attention  to  certain  stigmata  which, 
with  the  evidence  of  the  electronic  reactions  prove  to  be  fairly  constant  in 
hereditary  syphilis : — 'Argyll-Robertson  pupil,  tubercle  of  Caribelli  and 
the  auricular  and  digital  signs  of  Abrams. 

The  Argyll-Robertson  pupil  is  regarded  by  many  as  positive  proof  of 
nervous  syphilis. 

No  attention  has  been  directed  to  the  slow  or  sluggish  pupil  (reflex  to 
light),  which  I  find  to  be  fairly  constant  in  hereditary  syphilis.  It  may 
be  more  marked  in  one  eye.  Testing  for  tha  Argyll-Robertson  pupil  de- 
mands circumspection  (Vide  Physico-Clin.  Med.,  Dec.  1917,  p.  41). 

The  tubercle  of  Carabelli  is  a  supernumerary  cusp  (Fig.  21)  demon- 
strable on  the  palatine  surfaces  of  the  upper  first  large  molars.  The 
latter  yield  the  electronic  reaction  of  syphilis  and  radiograms  which  I 
had  made  of  a  number  of  them  show  diminished  density  (deficient  calci- 
fication) in  contrast  with  the  other  teeth. 

131 


Electronic      Reaction 


A-  JVormal  -Molar.- 3: Tubercle j      of 


FIG.   21. 


FIG.  22 — Auricular  Sign  of  Abrams. 

Incidentally,  I  may  mention  that  the  Hutchinsonian  teeth  also  show 
the  electronic  reaction  for  syphilis  whereas  the  other  teeth  in  the  same 
mouth  do  not.  The  auricular  sign  of  Abrams  consists  of  a  distinct  ridge 
running  from  the  antitragus  downwards  toward  the  lobule  (Fig.  22). 
This  ridge  when  palpated  has  a  cartilaginous  consistency.  The  digital  sign 
of  Abrams  (Fig.  23)  is  fairly  constant.  It  is  an  incurvation  of  the  little 
linger  (usually  implicating  the  second  phalanx). 

132 


Electronic      Reaction 


FIG.  23 — Digital  Sign  of  Abrams. 

ELECTRONIC  REACTIONS  WITH  BLOOD* 

A  few  drops  of  blood  taken  from  a  patient  and  allowed  to  dry  on  a 
slide  or  white  paper  will,  when  presented  directly  to  the  area  between  the 
third  and  fourth  dorsal  spines  of  the  subject,  yield  the  characteristic 
splanchnic  areas  of  dulness.  This  holds  for  active  tuberculosis,  syphilis 
("active  or  quiescent),  and  carcinoma.  In  the  affections  cited,  the  dried 
blood  yields  a  reaction  for  about  ten  days,  whereas  in  syphilis  a  reaction 
is  obtainable  for  several  weeks.  The  latter  fact  is  important  when  an 
acquaintance  with  the  luetic  reaction  is  studied.  After  this  manner,  diag- 
noses may  be  made  from  blood  sent  from  long  distances.  The  iblood  re- 
action is  a  general  one.  Thus,  if  the  blood  yields  a  tuberculous  reaction, 
it  suggests  tuberculosis  somewhere  in  the  organism;  the  localization  of 
which  is  possible  by  the  method  cited  elsewhere. 

In  presenting  the  specimen  side  of  the  paper  or  slide  to  the  spine,  grasp 
it  with  a  long  pair  of  forceps  (wood)  or  have  the  assistant  hold  it  at  its 
extreme  edge  during  the  time  percussion  is  executed. 

POLARITY. — Radiant  energy  in  disease  has  a  distinctive  polarity   (cor- 

•Reactions  are  executed  at  the  writer's  "Physico-Clinical  Laboratory," 
from  blood  sent  from  different  parts  of  the  United  States.  All  that  is 
necessary  is  to  forward  several  drops  of  blood  (covering  the  area  of  a 
25  cent  piece)  from  the  patient,  absorbed  by  clean  white  filter  paper. 
For  further  data  concerning  these  methods  the  reader  may  consult  the 
last  pages  of  this  book. 

133 


Electronic      Reactions 

roborative  evidence)  and  is  detected  by  presenting  a  bar-magnet  about 
four  inches  away  from  the  area  of  ventral  dulness.  The  magnet  must  be 
held  at  the  extreme  end  as  shown  in  fig.  24.  If  the  dulness  persists  with 


FIG.  24 — The  lower  figure  represents  the  correct  way  of  holding  the 
magnet  or  electrodes.  The  upper  figure  is  incorrect  owing  to  modification 
of  polarity  from  the  finger  tips  and  approximation  of  the  latter  to  the 
metal  which  causes  short-circuiting  and  interferes  with  conveyance  of 
energy.  The  magnet  should  be  held  at  the  extreme  tip.  W.hen  held  in 
the  center,  it  fails  to  yield  either  positive  or  negative  energy  sufficient  to 
determine  the  polarity  of  the  ventral  ara  of  dulness.  Be  sure  that  the 
magnet  is  correctly  marked  which  is  easily  determined  by  aid  of  a 
compass. 


the  positive  pole  (marked  N)  thus  presented  and  disappears  with  the 
negative  pole  (marked  S),  the  polarity  of  the  energy  is  positive,  and 
vice  versa.  If  it  persists  with  both  poles,  it  is  positive  and  negative  and 
it  it  is  dissipated  by  both  poles,  it  is  neutral  (isopolar). 

134 


Electronic 


e  a  c  t  i  o  n  s 


The  polarity  of  the  energy  in  carcinoma  is  positive  and  neutral,  in 
syphilis  and  tuberculosis. 

POTENTIALITY  OF  REACTION 

We  are  constrained  to  employ  electrical  terms  and  electrical  methods 
of  mensuration  until  our  knowledge  of  pathological  energy  is  better 
understood.  To  paraphrase  the  law  of  Ohm,  the  strength  of  pathological 
energy  varies  directly  as  the  energy  and  inversely  as  the  resistance. 

A  crude  method  for  measuring  the  energy  intensity  in  diesase  is  to  note 
at  what  distance  the  R.  E.,  is  from  the  source  of  energy  before  dulness 
appears. 

An  ohmmeter  is  more  exact.  The  rheostat  (Fig.  25)  for  this  purpose  is 
wound  to  carry  100  milliamperes  with  a  voltage  of  20.  The  scale  is  grad- 
uated from  1/25  of  an  ohm  to  1  ohm  and  then  up  to  50  ohms.  To  use  the 
rheostat,  place  the  R.  E.  (say  over  a  cancer)  and  the  other  electrode 
(between  the  third  and  fourth  dorsal  spines.  At  zero  of  the  scale,  the 
specific  dull  area  is  present.  Now  interpose  more  resistance  until  the 
dulness  disappears.  If  the  dulness  does  not  disappear  until  the  index 
registers  10  ohms,  then  the  energy  from  the  growth  has  a  potentiality  of 
10  ohms.  After  this  manner,  the  progress  of  a  growth  and  the  results  of 
treatment  may  be  gauged. 


FIG.  25. — Ohmmeter  (biodynamometer)  for  determining  in  ohms  the 
potentiality  of  energy.  The  resistances  are  as  follows:  1/25  of  an  ohm 
to  1  ohm,  1  to  10  ohms  and  10  to  50  ohms.  PB,  is  the  proximal  electrode 
(vertebral  application)  and  RE  represents  the  electrode  for  receiving  the 
energy  at  its  source.  Three  receiving  electrodes  are  shown  of  different 
sizes.  This  set  of  electrodes  is  known  as  Abram's  electrodes  for  the 
electronic  test. 

135 


Electronic      Reactions 

In  carcinoma,  the  potentiality  varies  from  1  (incipient  cancer)  to  30 
ohms, 

The  reaction  in  syphilis  is  always  present  and  in  this  sense  it  exceeds 
in  value  the  serological  tests.  In  quiescent  syphilis  the  potentiality  rarely 
exceeds  2/25  of  an  ohm;  in  active  syphilis,  it  may  exceed  10  ohms. 

The  splanchnic  reaction  is  elicited  even  over  a  healed  tuberculous  lesion 
but  the  energy  from  it  never  exceeds  a  potentiality  of  2/25  of  an  ohm. 
Active  lesions  may  show  a  potentiality  of  20  ohms.  Without  an  ohm- 
meter  at  our  disposal,  in  healed  tuberculosis,  the  reaction  is  present  cnly 
when  the  R.  E.  is  in  contact  with  the  skin.  If  a  reaction  is  elicited  at  a 
distance  exceeding  one  inch  from  the  skin  surface,  the  lesion  is  active. 
Thus,  in  one  patient,  when  the  R.  E.  was  held  at  a  distance  of  seven  inches 
from  the  tuberculous  lesion,  the  ohmic  resistance  was  6  ohms.* 

VIBRATORY  RATE. — Using  the  rheostat  after  the  manner  indicated,  it 
will  be  found  that  the  dull  abdominal  areas  will  only  appear  at  definite 
points  on  the  scale.  At  zero  always,  and  up  to  the  potentiality  of  the 
energy.  Otherwise,  the  dull  areas  will  appear  at  the  following  indices  of 
the  scale: 

Carcinoma,  30  or  50  ohms. 
Syphilis,  20  ohms. 
Tuberculosis,  15  ohms. 

The  writer  wishes  to  asseverate  that,  if  splanchno-diagnosis  is  approach- 
ed with  a  prejudiced  mind,  it  is  better  not  to  attempt  it,  for  there  are 
"none  so  blind  as  those  that  will  not  see." 

It  is  chiefly  indifference  that  has  relegated  to  oblivion  many  important 
truths. 

New  knowledge  is  always  viewed  critically  by  the  formalist  and  tra- 
ditionalist and  so  it  should  be,  particularly  when  the  innovationist  creates 
discontinuity  in  the  transition  to  new  knowledge.  Recent  developments  in 
science,  however,  have  shown  that  discovery  is  not  always  cumulative  in 
effect  but  there  are  also  precipitous  mutations.  The  theory  of  light  and 
electricity  as  vibratory  movements  of  the  ether,  was  not  established  until 
the  discovery  of  the  Hertzian  waves  and  finally  led  to  the  creation  of 
wireless  telegraphy. 

The  discovery  of  radium  demolished  precipitously  the  established 
theories  of  matter  and  force  so  that  chemistry  was  forced  to  tie  rewritten 
and  our  conception  of  the  constitution  of  matter  completely  changed.  The 
transmutation  theory  espoused  by  medieval  alchemy  and  the  object  of 
ridicule  prior  to  the  discovery  of  radium  appears  to  be  a  reality  after 
"a.11.  All  the  precautions  cited  must  be  sedulously  regarded  in  the  execu- 

,'s  :  JOfte  :of  the  main  <liiffiqtiitl/es:  by.  1;he  conventional  methods-  6t  diag- 
nosis is:  in  mjsinter.preitlng;  a  heated  for  an  active  tuberculosis  and  ac- 
counts for  the  observation  of  Roepke  that  10  per  cent,  of  the  iamafes 
or  sanatoria  for  tuberculosis  are  not  tuberculous. 


Electronic      Reactions 

tion  of  the  method.  The  writer  concedes  that  it  is  difficult  for  the  physi- 
cian or  physicist  to  grasp  the  import  of  the  reflexes  as  detectors  of  radio- 
activity. Unfortunately,  the  physician  is  not  a  physicist  nor  the  physicist  a 
physician.  Both  are  handicapped  in  the  assimilation  of  these  new  data  by 
the  radical  departure  from  standardized  methods  of  investigation.  The 
writer  has  proffered  his  services  to  the  French  Government  and  is  most 
eager  through  correspondence  or  otherwise  to  aid  physicians  in  executing" 
these  methods.  Reactions  in  diseases  other  than  here  cited  are  published  in 
the  writer's  Journal,  "Physico-Clinical  Medicine."  These  reactions  may 
be  corroborated  by  a  photokymograph  which  yields  syphygmograms  char- 
acteristic of  different  diseases.. 

SUPPLEMENTARY  REACTIONS 

The  viscera!  reflexes  of  Abrams,  have  been  investigated  and  confirmed 
by  many  notable  investigators.  In  France,  the  following  are  a  few  of  the 
investigators :  Heitz  (La  Presse  Medicale,  June  19,  1907)  ;  Merklen  and 
Heitz  (Examen  et  semiotoque  du  Coeur) ;  Jaworski  (Congress  of  Medi- 
cine, Oct.  10,  1911) ;  Lebon  and  Aubourg  (Societe  de  Radiologie  Medicale 
de  Paris)  and  Houlie  (Bulletins  et  Memoires  de  la  Societe  de  Medicine). 

(March  19,  April  10  and  May  8,  1914)*.  The  aortic,  cardiac  and  pul- 
monary reflexes  were  discussed  -by  the  writer  in  La  Presse  Medicale, 
April  3,  1907,  and  Oct.  4,  1911. 

PULMO ^-DIAGNOSTIC  REACTIONS 

It  is  known  that  if  one  stimulates  the  area  between  the  4th  and  5th 
cervical  spines,  one  may  provoke  the  lung  reflex  of  contraction  '(S.  313). 
This  lung  contraction  which  implicates  both  lungs  may  foe  viewed  Roent- 
genoscopically.  Like  in  splanchno-diagnosis  radioactivity  in  disease  is  a 
question  of  wave  length  and  definite  diseases  having  an  energy  of  specific 
vibratory  rates  will  only  stimulate  certain  bronchoconstrictor  fibers  In  the 
vagus  and  only  definite  pulmonary  areas  will  contract.  The  latter  are 
usually  demonstrated  by  percussion  although  they  may  be  shown  by  careful 
inspection  with  the  fluoroscope.  In  the  elicitation  of  the  pulmo-diagnostic 
reactions,  the  method  of  execution  is  the  same  as  in  splanchno-diagnosis 
with  the  only  difference  that  the  energy  from  the  patient  to  the  subject  is 
conveyed  to  the  area  between  the  4th  and  5th  cervical  spines  of  the  latter. 
These  reactions  will  confirm  the  evidence  of  splanchno-diagnosis.  Only 
the  reactions  in  carcinoma  and  syphilis  will  be  shown  here. 

PULMO-DIAGNOSTIC  REACTION  IN  CARCINOMA 

To  increase  the  interscapular  region,  the  subject  places  his  right  hand 
on  his  left  shoulder  and  the  other  hand  on  the  right  shoulder.  In  carci- 
noma, an  area  of  absolute  dulness  during  energy  conveyance  appears  (lo- 

*Prior  to  the  present  war,  Houlie,  was  engaged  on  the  translation  in  Jr. 
French  of  the  writer's  book  on  the  reflexes  (Spondylotherapy). 

137 


Electronic      Reactions 

cation  defined  with  arms  hanging)  in  the  left  interscapular  region 
(Pig.  26).  The  polarity  of  this  dulness  like  in  splanchnodiagnosis  is  posi- 
tive, i.  e.,  on  presentation  of  the  positive  pole  of  a  bar-magnet  to  the  area 
of  dulness,  the  latter  persists  but  disappears  when  the  negative  pole  is 
thus  presented.  Like  the  succeeding  reaction  (syphilis),  it  also  disap- 
pears temporarily  when  the  subject  is  placed  in  the  magnetic  meridian  (35) 
'and  by  eliciting  the  counter  reflex  of  lung  dilatation  by  rubbing  the  skin 
over  the  site  of  the  dulness. 

PULMO-DIAGNOSTIC  REACTION  IN  SYPHILIS 

The  area  of  dulness  (Fig.  26)  is  located  in  the  right  interscapular  region. 
The  polarity  of  the  energy  in  syphilis  is  neutral  hence,  the  dulness  disap- 
pears when  either  pole  of  the  bar-magnet  is  presented. 


FIG.  26. — Pulmo-Diagnostic  Reactions  in  Carcinoma    (A)   and 
Syphilis    (B). 


ENTERO-D1 AGNOSTIC  REACTIONS 

Stimulation  (by  percussion)  of  the  2nd  lumbar  spine  causes  dulness 
of  the  entire  abdomen  owing  to  elicitation  of  the  intestinal  reflex  of  con- 
traction (Abrams).  Like  the  splanchno-diagnostic  and  pulmo-diagnostic 
reactions,  specific  rates  of  energy  will  evoke  definite  localized  areas  of 
ventral  dulness  which  unlike  the  splanchno-diagnostic  reactions  do  not 
temporarily  disappear  by  deep  breathing  or  extension  of  the  head  on  the 
neck  but  disappears  temporarily  by  slight  irritation  of  the  skin  over  the 
area  of  dulness.  The  method  of  procedure  is  like  the  others  'but  the 
energy  is  conveyed  by  the  conducting  cord  to  the  2nd  lumbar  spine.  The 
areas  noted  in  tuberculosis,  carcinoma  and  syphilis  are  shown  in  fiig.  27. 

138 


Electronic      Reactions 


FIG.  27 — Entero-Diagnostic  Reactions  in  carcinoma  (A);  tuberculosis 
(B)  and  Syphilis  (C).  A  and  B  are  practically  in  the  same  situation  and 
the  areas  are  differentiated  by  their  vibratory  rates  (q.  r.). 

AUTO-ELECTRONIC  REACTIONS 

By  aid  of  these  reactions  which  the  writer  has  recently  developed,  one 
may  dispense  with  an  intermediary  (subject)  and  employ  the  patient.  To 
a  certain  extent  the  auto  are  more  convenient  than  the  heteroreactions 
heretofore  employed  yet,  there  are  many  instances,  notably  when  the  ab- 
domen of  the  patient  is  universally  dull  that  it  is  difficult  to  differentiate 
ventral  areas  of  dulness.  In  such  instances  the  pulmo-diagnostic  reac- 
tions are  alone  available.  As  in  heterosplanchnodiagnosis,  the  patient 
faces  the  west  and  stands  on  a  plate  of  aluminum.  Mention  will  only  foe 
made  of  the  diagnosis  of  syphilis  although  this  method  is  equally  ap- 
plicable in  other  diseases.  In  syphilis,  one  finds  the  usual  epigastric  area 
of  dulness  and  in  congenital  syphilis  the  additional  area  between  the  navel 
and  symphysis  pubis.  There  will  also  'be  an  area  of  dulness  located 
midway  on  a  line  drawn  from  the  middle  of  the  right  groin  to  the 
navel,  known  as  the  enterodiagnostic  reaction  (C  Fig.  27)  and  appears  in 
heterosplanchnodiagnosis  (subject  used)  when  energy  from  the  spine  of 
the  patient  is  conveyed  to  the  2nd  lumbar  spine  of  the  subject.  One  also 
finds  in  the  patient  an  area  of  dulness  of  the  lung  (Fig.  26).  The  latter 
is  known  as  the  pulmo-diagnostic  reaction.  All  these  areas  of  dulness  dis- 
appear when  either  pole  of  a  magnet  is  presented  toward  the  area  of  dul- 
ness insomuch  as  the  energy  of  syphilis  is  neutral.  The  pulmo-diagnostic 
and  entero-diagnostic  areas  of  dulnes  disappear  temporarily  when  the  skin 
over  the  sites  of  the  dulness  is  irritated  whereas  the  spianchnovascular 
diagnostic  area  (a>bove  the  navel)  disappears  temporarily  when  the  head 
is  extended  or,  after  repeated  deep  breathing. 

One  may  measure  the  potentiality  of  the  energy  in  auto  like  in  hetero- 

139 


Electronic      Reactions 

splanchnodiagnosis.*  Another  valuable  discovery  connected  with  these 
reactions  is  the  auscultatory  phenomena  -noted  over  the  dull  lung  area 
(whether  the  subject  or  the  patient  is  employed). 

Over  the  area  of  dulness  one  may  hear  a  distinct  and  faint  hum,  atelec- 
tatic  crepitation  or  bronchovesicular  respiration.  These  varied  auscultatory 
phenomena  must  be  carefully  studied  or  otherwise,  they  may  escape  de- 
tection. Phonendoscopic  stethoscopes  should  not  be  used  as  the  confus- 
ing sounds  indigenous  to  them  may  conduce  to  error  in  the  interpretation 
of  the  pulmonary  sounds.  Note  the  resumption  of  normal  respiration 
when  the  positive  or  negative  pole  of  a  bar-magnet  is  presented  to  area 
of  dulness  in  syphilis  or  the  negative  pole  to  the  area  in  carcinoma.  In 
auscultating,  avoid  pointing  the  fingers  in  the  direction  of  the  stethoscope. 
The  energy  from  the  fingers  may  nullify  the  dulness. 

When  auto-electronic  reactions  are  contemplated,  attempt  to  secure  an 
abdomen  free  from  dulness  by  purgation  and  enemata  and  by  abdominal 
massage  and  forcible  inspirations  to  eliminate  intraabdominal  congestion. 
These  reactions  constrain  us  to  study  symptomatology  from  an  electronic 
viewpoint.  A  symptom  is  invariably  a  reflex  superinduced  by  the  radiant 
energy  of  disease  (always  of  a  definite  vibratory  rate)  acting  upon  definite 
cerebrospinal  structures. 

Just  as  radium  confers  radioactivity  on  other  substances  so  may  a  can- 
cerous person  by  induction  alter  the  polarity  and  vibratory  rate  of  another 
individual  (184).. 

Take  a  cancer  specimen,  place  the  corked  end  of  the  bottle  containing  it 
against  the  leg  or  any  part  of  the  body  of  an  individual  and  note  that,  after 
a  few  minutes  the  splanchnovascular,  enterodiagnostic  and  pulmodiagnos- 
tic  reactions  in  that  individual  may  be  elicited  during  the  time  the  bottle  is 
in  contact  with  his  body. 

VASOMOTORIAL  DIAGNOSIS 

Reference  has  been  made  (vide  antea)  to  vasomotor  reactions.  The 
ear  of  a  white  rabbit  is  admirably  adapted  for  this  purpose.  After  the 
animal  is  hypnotized  by  stroking  its  back,  place  the  animal's  ear  between 
two  squares  of  white  glass  held  in  a  support.  View  the  ear  directed  to  the 
light  (artificial  light  will  nullify  the  reactions)  which  must  not  be  too 
intense.  Note  the  pallor  or  flushing  invariably  in  definite  regions  of  the 
ear  (Fig.  28)  when  the  energy  of  disease  is  conveyed  respectively  to  the 
1st  dorsal  spine  or  the  area  between  the  3rd  and  4th  dorsal  spines.  These 

*If  one  grounds  the  area  between  the  3rd  and  4th  dorsal  spines,  the 
2nd  lumbar  spine  or  the  area  between  the  4th  and  5th  cervical  spines 
in  executing  the  autoelectronic  reactions,  one  causes  to  disappear  the 
splanchnovascular,  enterodiagnostic  and  pulmodiagnostic  areas  of  dulness. 
Using  an  ohmmeter,  the  areas  of  dulness  reappear  at  the  vibratory  rates 
of  the  different  diseases. 

140 


Electronic      Reaction 


St>{  ^OCOCCUi 


IJJ.WM 


FIG.  28. — Specific  areas  of  pallor  or  flushing  of  the  ear  of  a  white  rabbit. 
The  dotted  lines  represent  the  blood-vessels. 

spines    are    easily   counted   in    the   rabbit.      Cultures    of    streptococci   or 
tubercle  bacilli  may  substitute  the  energy. 

If  a  healthy  subject  faces  the  west  and  the  ocular  conjunctiva  is  ob- 
served, note  that  on  grounding  the  1st  dorsal  spine,  the  blood  vessels 
dilate  and  conversely,  they  contract  when  the  area  between  the  3d  and 
4th  dorsal  spines  is  grounded  (vide  antea).  These  phenomena  also  noted 
at  definite  vibratory  rates  enable  one  to  differentiate  disease. 


FIG.  29 — Area  of  pallor  or  flushing:  in  a  syphilitic  superinduced  by 
grounding  the  vasodilator  or  vasoconstrictor  center  in  the  cord.  The  area 
represents  a  streak  slightly  above  the  lower  border  of  the  lobulus  -of  the 
auricle. 

141 


Electronic      Reactions 

Grounding  after  the  manner  indicated  in  a  person  afflicted  with  disease 
and  observing  the  ear  opposite  the  light  (person  facing  west),  one  may 
note  pallor  or  flushing  in  definite  areas  of  the  ear  (Fig.  29).  Tuberculous 
energy  (Fig.  15),  syphilitic  and  carcinomatous  energy  thus  applied  to  the 
vertebral  regions  in  question  may  produce  pallor  or  flushing  in  definite 
regions  of  the  ear  when  a  subject  is  used  (Fig.  29),  and  these  phenomena 
may  be  accentuated  by  grounding  (vide  antea). 

Symptom's  are  only  reflexes ;  definite  responses  to  definite  vibratory 
energy  rates  acting  on  definitely  attuned  centers. 

CARDIAC  AND  PUPILLARY  REACTIONS 

Cardiac  and  pupillary  reflexes  may  be  utilized  in  diagnosis.  In  both,  one 
employs  the  ohmmeter  at  the  vibratory  rates  of  disease.  In  using  the 
heart,  select  an  individual  with  a  regular  pulse  and  note  that  when  the 
electrode  is  fixed  in  the  3rd  right  intercostal  space  contiguous  to  the  stern- 
um (sinus  node  location)  and  energy  of  disease  is  conveyed  at  the  vibra- 
tory rate,  there  is  a  momentary  inhibition  of  the  pulse.  The  writer  has 
succeeded  in  obtaining  specific  pulse  curves  in  different  diseases  (patho- 
sphygmography).  The  mydriatic  pupillary  tract  (97)  may  be  stimulated 
when  energy  is  conveyed  to  the  1st  and  2nd  dorsal  spines.  Mydriasis 
follows  such  stimulation  at  the  vibratory  rates  specific  for  each  disease. 
Other  reflexes  are  described  in  "New  Concepts  in  Diagnosis  and  Treat- 
ment." 

HOMO-SEXUALITY* 

My  recent  observations  only  emphasize  the  importance  of  regarding 
vital  phenomena  as  processes  and  not  as  structures.  Every  tissue  pos- 
sesses its  own  definite  radioactivity  which  may  be  readily  demonstrated 
by  aid  of  the  electronic  reactions.  Specifically,  the  ovary  yields  definite 
areas  of  ventral  dulness  and  this  is  likewise  true  of  the  testes. 

Six  homosexualists  (males?)  thus  far  examined  yielded  from  anatomic- 
ally perfect  testes  an  ovarian  reaction  in  four  instances  and  in  the  other 
two  subjects  (bisexualists),  an  ovario-testicular  reaction  (ovarian  by 
measurement  predominating). 

These  phenomenal  facts  are  of  stupendous  importance  and  justify  a 
more  intensive  study  of  this  interesting  subject.  Anatomy  is  no  aid  in 
differentiating  sexuality.  Many  believe  that  both  sexes  are  potentially 
existent  in  both  the  female  and  male  germ  cell. 

The  rudiments  of  the  accessory  apparatus  (Wolffian  and  Miillerian 
ducts)  are  common  to  both  sexes.  The  sexual  glands  also  consist  (in 
addition  to  the  specific  glands  of  generation)  of  Leydig's  interstitial  tissue 
(epithelioid  cell  accumulations  imbedded  in  the  sexual  glands  of  the  male). 

•Tide  page  76. 

142 


Electronic      Reactions 

Insomuch  as  recent  observations  show  that  these  interstitial  glands  are 
directly  responsible  for  the  primary  and  secondary  sexual  characters,  an 
histologic  study  of  the  testes  as  ordinarily  pursued  cannot  aid  in  the  dif- 
ferentiation of  testicular  from  ovarian  structure. 

ELECTRONOTHERAPY 

Just  a  few  words  should  foe  accorded  to  the  writer's  new  concepts  in 
treatment  (193  et  seq.) 

Electromagnetic  waves  have  no  effect  on  olbjects  which  are  incapable  of 
vibrating  with  them  and  as  Abderhalden  observes,  "Bodies  out  of  har- 
mony with  the  tissues  are  either  not  absorbed  or  changed  before  ab- 
sorption." 

Wireless  transmitters  and  receivers  can  be  "tuned"  to  respond  to  elec- 
trical impulses  of  specific  wave  length  alone.  It  is  this  principle  of  sympa- 
thetic vibration  which  has  been  applied  to  the  control  of  machinery  at  a 
distance  and  the  guidance  of  boats. 

The  writer  has  demonstrated  by  aid  of  the  biodynamometer  (Fig.  25) 
that  all  of  the  specific  drugs  have  the  same  specific  wave  length  as  the 
diseases  for  which  they  are  employed.  This  refers  to  syphilis,  malaria, 
gout,  and  polyarthritis. 

My  investigations  show  that  ideal  pharmaco-dynamics  in  disease  aims  to 
change  the  polarity  of  the  soil  (I  have  called  this  polaritherapy)  and  to 
use  radioactive  drugs  which  show  the  same  vibratory  rate  as  disease  (I 
have  specified  this  process  as  oscillatotherapy).  Both  methods  are 
embraced  under  the  general  neologism,  Electronotherapy. 

Like  many  others  of  the  so-called  "Regular  School,"  I  ridiculed  the 
doctrines  of  homeopathy  -but  now  the  writer  is  constrained  to  retract  an 
opinion  based  on  belief  and  not  on  fact. 

The  Hahnemannian  doctrine  of  attentuation  is  not  a  myth.  It  can  be 
demonstrated  by  aid  of  the  'biodynamometer  and  the  reflexes'  that  the 
mechanical  subdivision  of  drugs  or  their  dilution  will  augment  their  radio- 
active potency.  From  what  has  been  said,  the  law  of  similars  (similia 
similibus  curantur)  is  a  verity.  Pharmacodynamics  is  identified  with  what 
I  have  called  homovibrations  and  drugs  of  dissimilar  vibrations  (hetero- 
vibrations)  are  without  remedial  value. 

ELECTRON VLOGICAL  DATA* 

EI.ECTRONOLOGY. — Like  radioactivity,  this  is  a  new  primary  science  and 
bears  no  allegiance  to  cytological  medicine.  This  drastic  innovation  in 
diagnosis,  pathology  and  therapeutics,  predicates  a  knowledge  of  the  recent 
developments  in  physicochemistry  and  it  would  be  puerile  to  assume 

*The  subject-matter  under  this  caption  has  been  developed  by  the 
author  since  the  publication  of  "New  Concepts  in  Diagnosis  and  Treat- 
ment" and  some  of  it  is  more  fully  elaborated  in  his  Journal,  "Physico- 
Clinical  Medicine." 

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that,  its  mastery  can  be  attained  without  painstaking  study  preceded  by 
the  conviction,  however,  that  anything  can  be  true  however  marvelous. 
Electronology  is  destined  to  solve  problems  in  science  and  medicine  in  par- 
ticular before  regarded  as  insoluble.  Electronic  diagnosis  appeals  to  the 
uninitiated  like  the  mythical  fabrications  of  an  Homeric  poem  in  which 
with  a  blow  of  the  hand,  the  heroes  destroy  worlds.  The  simple  story  of 
its  evolution  can  be  inscribed  in  three  chapters :  1.  Discovery  of  the  vis- 
ceral reflexes;  2.  Recognition  of  the  fact  that  electrons  and  not  cells  are 
the  ultimate  constituents  of  the  organism  and  that  in  the  incessant  activ- 
ity of  the  electrons,  radioactivity  or  its  equivalent  energy  is  evolved, 
which  has  an  invariable  vibratory  rate;  3.  That  the  reflexes  surpass  in  sen- 
sitivity any  scientific  contrivance  for  the  recognition  of  this  radioactivity. 

MULTIPLICITY  OF  REACTIONS. — In  hetero — or  autoelectronic  diagnosis,  sev- 
eral reflexes  may  be  present  synchronously;  thus  in  tuberculosis  with 
mixed  infection,  the  tuberculous  as  well  as  the  streptococcic  areas  of 
dulness  can  be  elicited.  In  heterodiagnosis,  the  subject  must  be  exempt 
from  the  disease  for  which  the  reaction  is  sought. 

SPHYGMOMANOMETRIC  INDEX. — Using  a  sphygmomanometer  (with  an 
aneroid  barometer)  and  conveying  the  energy  to  the  heart  (vide  cardiac 
reactions)  of  a  subject,  note  that,  at  the  vibratory  rates  of  syphilis  (20), 
tuberculosis  (15)  and  cancer  (30  or  50),  there  will  be  a  slight  and  tran- 
sitory inhibition  of  the  oscillations  of  the  needle  followed  by  an  infinitesi- 
mal deflection  of  the  needle  toward  a  higher  point  on  the  scale  (85).  Exe- 
cute these  observations  when  the  needle  shows  its  maximum  oscillations 
and  remember  that  the  heart  will  soon  exhaust  itself  when  used  for  these 
test  purposes. 

ARGYLL-ROBERTSON  PUPIL.— 'This  is  claimed  to  be  due  to  a  break  in  the 
reflex  arc.  This  is  not  true.  When  it  is  partial,  ground  the  mydriatic 
pupillary  tract  (vide  pupillary  reactions)  and  note  that  the  light  reflex 
is  more  responsive  during  than  before  grounding.  I  assume  that  the 
toxinosis  of  syphilis  has  a  selective  action  on  the  mydriatic  tract  thus 
opposing  the  action  of  the  myotic  pupillary  tract. 

IMMUNODIAGNOSIS. — The  electronic  reactions  enable  one  to  say  whether 
the  individual  possesses  a  natural  or  acquired  immunity  to  certain  diseases. 
Thus  typhoid  bacilli  (culture)  yield  a  definite  area  of  ventral  dulness.  The 
blood  of  all  patients  who  have  had  typhoid  fever  will  dissipate  this  dulness. 
This  is  not  so  with  many  persons  who  have  not  contracted  the  disease. 
Many  other  diseases  are  similarly  amenable  to  immunodiagnosis  (Physico- 
Clin.  Med.,  Sept.,  1917).  Vide  Specific  Medication. 

CONGENITAL  SYPHILIS. — The  general  pulmo-diagnostic  reaction  has  been 
noted.  In  the  hereditary  form,  there  is  an  additional  area  of  dulness  at 
the  manubrium  sterni.  With  the  enterodiagnostic  reflex,  there  is  in  this 
form,  a  finger-breadth  dulness  located  in  the  epigastrium  at  the  outer 

144 


Electronic      Reactions 

border  of  the  rectus  abdomini's  on  the  left  side.  Congenital,  is  no  abso- 
lute protection  against  acquired  infection.  We  have  found  that  the  po- 
tentiality of  the  suprapublic  area  of  dulness  may  be  lower  than  the 
epigastric  area.  In  the  norm  in  the  congenital  form,  both  areas  show  the 
same  potentiality. 

TUBERCULOUS  LYMPHADENITIS. — Normal  lymph  glands  and  the  tonsils 
yield  the  reaction  of  tuberculosis  (pseudotuberculous  reactions)  not  at  15, 
of  the  scale  of  the  ohmmeter,  but  at  3,  and  the  polarity  is  positive.  These 
structures  contain  bodies  immune  to  tuberculosis.  Vide  specific  medication. 

SPECIFIC  MEDICATION. — "The  diseases  of  which  we  know  the  least  path- 
ology are  the  diseases  which  we  treat  successfully."  Many  of  our  most 
potent  drugs  are  of  empirical  genesis.  The  electronic  reactions  aid  us  in 
interpreting  medicamentous  action. 

Syphilis  and  malaria  evoke  definite  ventral  areas  of  dulness  and  like 
areas  are  produced  by  mercury  and  quinine.  The  latter  drugs  will  dissi- 
pate the  dull  areas  of  syphilis  and  malaria.  Pharmocodynamics  is  thus 
identified  with  homovibrations  (homovibratotherapy).  This  action  of 
drugs  is  exemplified  by  the  physical  analogy  of  resonance.  Disease,  like 
other  entities,  has  a  natural  period  of  vibration  and  if  we  approach  an 
object  with  a  source  of  vibration  of  the  same  vibratory  rate  as  itself,  the 
object  will  be  set  in  vibration. 

This  forced  vibration  of  the  object  may  attain  such  magnitude  as  to 
fracture  and  utterly  destroy  it.  Investigating  the  action  of  drugs  used  in 
syphilis  after  this  manner,  I  found  that  the  splenic  extracts  were  the  most 
efficient  and  in  the  treatment  of  this  disease,  I  use  in  combination  with  the 
specific  drugs  concussion  of  the  2nd  lumbar  spine  (thrice  daily)  with  two 
objects  in  view:  forcing  the  spirochetes  and  their  toxins  from  their 
"blind"  habitat — the  spleen  and  forcing  from  the  latter  into  the  circula- 
tion, its  immunizing  bodies. 

Eosin  is  a  marvelous  remedy  in  the  treatment  of  cancer.  I  can  employ 
no  other  word  to  justify  this  conclusion  based  on  the  observations  of 
others  and  myself.  By  virtue  of  its  neutral  rays,  it  neutralizes  the  positive 
soil  (193  et  seq.)  of  cancer.  In  gonorrhea  and  gonorrheal  rheumatism,  its 
action  is  equally  efficient  by  neutralizing  the  positive  and  negative  soil  of 
the  disease. 

Gamboge  painted  on  the  chest  in  lung  tuberculosis  is  practically  a  spe- 
cific in  this  disease  and  incipient  cases  are  symptomatically  cured  in  sev- 
eral weeks. 

In  the  latter  citations,  the  pharmacal  effects  are  secured  by  polari- 
therapy. 

The  inefficiency  of  radium  (compared  with  eosin)  in  the  treatment  of 
cancer  is  due  to  the  fact  that,  the  alpha  or  positively  charged  rays  which 
possess  over  95  per  cent,  of  the  energy  evolved  from  radioactive  sub- 
stances only  serve  to  contribute  to  the  growth  of  a  carcinoma  which  like- 

145 


Electronic      Reactions 

wise  shows  positive  radioactivity.  Owing  to  the  action  of  specifics  in  modi- 
fying the  reaction  of  a  disease,  say  mercury  in  syphilis,  measurements  to 
determine  the  progress  of  the  disease  while  the  patient  is  undergoing  treat- 
ment must  be  made  with  two  rheostats.  The  index  of  one  rheostat  must 
be  placed  at  the  vibratory  rate  of  the  disease  (20  in  syphilis).  After  this 
manner,  the  potentiality  of  the  disease  will  be  uninfluenced  by  the  mer- 
cury or  other  preparation  used. 

TELEDIAGNOSIS — Radiant  energy  may  be  conveyed  over  a  telephone  wire. 
After  this  manner  sucessful  diagnoses  (with  patients  whose  diseases  were 
unknown  to  the  author)  were  made  between  Los  Angeles  and  San  Fran- 
cisco, a  distance  of  475  miles. 


FIG.  30 — (1)    Splanchnovascular  reactions  of  lead    (A)   and   steel    (B): 
(2)  Enterodiagnostic  reactions  of  lead   (A)  and  steel   (B). 


FIG.  31. — (3)  Splanchovascular  reactions  of  the  tetanus  bacillus  (A) 
and  the  bacillus  aerogxmes  capsulatus  (B).  (4)  Enterodiagnostic  reac- 
tions of  the  tetanus  bacillus  (A)  and  the  bacillus  aerogones  (B). 

CANCER  AND  INFLAMMATION. — These  border-line  affections  may  be  dif- 
ferentiated.    Inflammation  yields  a  reaction  like  carcinoma,  but  the  latter 

146 


Electronic      Reactions 

does  not  produce  the  inflammatory  reaction  in  the  area  similar  to  congeni- 
tal syphilis  (Fig.  18).  The  inflammatory  reaction  in  the  carcinomatous 
area  is  only  reproduced  at  the  vibratory  rate  of  40,  and  not  at  30  and  SO, 
as  in  carcinoma.  The  latter  only,  yields  an  additional  dulness  strictly  limit- 
ed to  the  navel.  The  foregoing  refer  to  the  splanchnovascular  reactions. 

PLANTS. — Smith  (U.  S.  Dept.  of  Agriculture),  suggests  that  crown 
gall,  a  cancer  of  plants  is  due  to  the  bacterium  tumefaciens,  'Specimens 
received  from  him  yield  reactions  identical  with  human  cancer. 

When  the  stem  of  a  flower  is  torn  (not  cut)  from  a  growing  plant,  or 
the  stem  of  a  fresh  flower  is  torn,  the  electronic  reactions  of  pain  may  be 
demonstrated,  hence,  plants  suffer. 

GUNSHOT  WOUNDS. — Lead  and  steel  are  the  essential  elements  of  pro- 
jectiles and  their  electronic  reactions  may  be  noted  in  fig.  30.  Vide  also 
fig.  31. 

POSTURAL  POLARITY. — In  all  electronic  reactions  the  patient  and  subject 
must  face  west  (body  parallel  with  the  earth's  axis).  Our  earth  is  a 
gigantic  magnet  with  magnetic  poles.  It  is  generally  accepted  although 
the  reverse  may  be  true,  that  out  of  the  earth's  north  magnetic  pole  in  the 
Southern  Hemisphere  a  stream  of  magnetic  flux  emerges  which  traverses 
the  atmosphere  until  it  attains  the  earth's  south  magnetic  pole.  If  the 
patient  or  subject  with  cancer  faces  north,  the  dull  areas  peculiar  to  can- 
cer persist  but  they  are  dissipated,  when  a  posture  facing  south  is  as- 
sumed; the  magnetic  flux  from  the  south  is  negative  and  neutralizes  the 
positive  energy  of  cancer. 

UTILIZATION  OF  THE  HEART  IN  DIAGNOSIS. — Reference  has  already  been 
made  to  this  subject.  Characteristic  sphygmograms  are  shown  in  fig  32. 


FIG.  32. — A,  shows  the  tracing  in  cancer  and  B,  the  tracing  in  tuber- 
culosis. The  departure  from  the  normal  curves  as  shown  by  the  dotted 
lines  is  constant  in  both  diseases  and  is  of  great  significance  to  the 
physician  skilled  In  the  interpretation  of  pulse  tracings. 

LAW  OF  COLLES. — This  law  may  be  sustained  by  the  electronic  reactions. 
In  several  instances  where  the  fathers  were  syphilitic  and  the  mothers 
yielded  no  reaction  for  syphilis  the  energy  transmitted  from  the  preg- 
nant uteri  and  from  the  latter  only,  the  reaction  of  syphilis  could  be 
elicited. 

147 


Electronic      Reactions 

AUSCULTATORY  PERCUSSION — To  facilitate  recognition  of  dulness  by  elec- 
tronic diagnosis,  utilize  the  method  described  elsewhere  in  this  book 
CS560). 

ELECTRONESTHESIA. — Recently,  I  have  found  that  the  zones  of  dulness 
in  splanchno  and  enterodiagnosis,  show  modifications  in  epicritic  and 
protopathic  sensibility  (S12)  during  the  time  the  energy  is  conveyed 
(within  10  seconds)  in  subjects  and  when  the  patient  is  examined  (auto- 
electronic  diagnosis).  These  cutaneous  changes  in  sensibility  are  strictly 
limited  to  the  areas  of  dulness  when  the  patient  is  facing  west  (grounded) 
and  standing.  Either  patient  or  subject  must  be  told  to  concentrate  (an- 
swering sharp  or  dull  each  time  skin  contact  is  made),  informed  of  what 
is  to  be  expected  and  the  very  slight  modifications  of  sensation  which  will 
ensue.  These  suggestions  can  later  be  controlled  during  the  examination 
when  the  eyes  of  the  subject  or  patient  are  closed  and  the  areas  of  modi- 
fied sensibility  delimited  by  a  pencil.  Repetition  of  the  examination  will 
show  the  limitations  of  the  areas.  The  enterodiagnostic  areas  show  greater 
modifications  than  the  splanchnovascular  areas.  Use  a  wooden  probe 
•wound  loosely  with  cotton-wool  at  one  end  and  pointed  at  the  other  end. 
Direct  fingers  away  from  the  areas  (Fig.  24). 

The  epicritic  sensibility  shows  hyperalgesia  and  the  protopathic  sen- 
sibility, diminished  sensibility  (hypesthesia).  Exercise  care  by  making 
uniform  strokes  with  the  cotton  and  guide  the  uniform  depth  of  pressure 
•with  the  pointed  end  of  the  probe  by  aid  of  the  fingers.  The  phenomena 
cited  are  not  unlike  the  hyperalgesic  dermatomes  (S58)  and  are  similarly 
explained.  When  the  pulmodiagnostic  areas  are  investigated  they  show 
hypesthesia  strictly  limited  to  the  dull  areas. 


148 


INDEX 


Abrams,  Electronic  Reactions  of,  120 

Abrams,  Reflexes  of,  121 

Abrams,  Signs  of,  132,  133 

Agalorrhea,  9,  118. 

Alcohol,  69 

Amenorrhea,  7 

Aneurysm,  5,  114 

Anesthetics,  70 

Angina  Pectoris,  22,  25,  112 

Appendicitis,    14,    16,    116. 

Appendix,  116 

Argyll-Robertson  Pupil,  131,  144 

Arrhythmia,   113 

Asthma,  12,  22,  26,  115 

Attunement,  58 

Aura,  71 

Autoelectronic  Reactions,  139 

Baird,  36 

Barr,  Sir  James,  5.  Ill,  114 

Blood-pressure,  28,  29 

Blood  Reactions,  133 

Bond,  3 

Boyce,  41 

Buchanan,  68 

Caesar,  116 

Cancer,   Diagnosis   of 

87,  136,  137,  140,  146 
Cancer,  Heart  in,  26 
Cancer,  of  Plants,  147 
Carabelli,    131 
Cardiac,  Insufficiency,  26 
Cecum,  116 
Cellular  Pathology,  50 
Centers,  Energy,  60 
Cereforasthenia,  37 
Cervix  Dilatation,  10 
Chiropractic,  103 
Chloroform,  89 
Circulation,  Splanchnic,  113 
Circulatory    System,   21 
Cirrhosis,  117 
Cohen,  26,  39,  111,  118 
Colles,  Law  of,  147 
Colors,  58,  66,  77,  126,  127 
Concussion,  110 
Conduction,  53 
Constipation,  6,  32 
Cystocele,  7 


Dawson,  10 
Death,  100 

Dementia,  Paralytica,  91 
Dementia  Precox,  93 
Depressor    Nerve, 

112,  113,  114,  122,  123 
Diagnosis,  82,  120 
Diagnosis,  Precautions,  126 
Diagnosis,  Splanchno,  122 
Diagnosis,  Vasomotorial,   140 
Digestive  System,  29 
Duodenal  Ulcer,  8,  116 
Dyspepsia,  29 

Electrocution,  9 
Electron,  51,  52,  83 
Electronesthesia,  148 
Electronic,  Diagnosis,  88 
Electronic,  Reactions,  95,  120,  et  seq. 
Electronic,  Theory,  50,  121 
Electronic,  Therapy,   143 
Electronological,  Data,  143 
Energy,  Human,  49,  52,  53,  68,  69 
Energy,  Pathological,  89 
Enterodiagnostic  Reactions,  138 
Enuresis,  7 
Eosin,  145 
Epilepsy,  100 
Exophthalmic  Goitre,  5,  12,  114 

Freezing,  36,  108,  111 
Freud,  2 

Gall,  Bladder,  32 
Gall,  Stones,  33 
Galton's  Whistle,  59 
Gamboge,  145 
Gastrograph,   59 
Gastrometer,  54 
Goitre,  5,  12,  114 
Gonorrhea,  145 
Gordon,  26,  27 
Griffin,  107 
Guild,  36,  37 
Gunshot  Wounds,  147 
Gynecology,  6,  118 

Haeberle,  91 
Hay  Fever,  9 
Heart,  Dilated,  24,  25 


149 


n 


e 


x 


Heart,  in  Diagnosis,  147 
Heart,  Neuroses,  112 
Heart,  Reactions,  142 
Heart,  Reflex,  26,  111,  112 
Hemoptysis,  118 
Hepatic  Congestion,  8 
Hirsch,  25,  113 
Homeopathy,   143 
Homosexuality,  76,  142 
Houlie,  114 
Human  Aura,  71 
Human,  Energy,  49,  S3,  68,  69 
Hutchinson  Teeth,  132 
Hylozoism,  120 
Hypertension,  113 
Hypoazoturia,  28 

Impotency,  77 
Immunodiagnosis,  144 
Inflammation,  146 
Intestinal  Reflexes,  116 
Ireland,  6,  33,  40,  43  118 
Irritation,  Sympathetic,  65 

Jarvis,  13,  21,  35,  70,  106,  108 

Kidney,  40,   118 
Kilner,  71 

Labor,  43,  118 

Lebon  and  Aubourg,  32,  105 

Level,  Pelvic,  42 

Levison,  85 

Liniments,  67 

Lung,  Reflexes,  115 

Lydston,  91 

MacDonald,  116 
Malaria,  41,  117 
Medication,   Specific,  145 
Mentoids,  70 
Metrorrhagia,  7 
Migraine,  39,  118 
Minerbi,  112 
Mitral  Lesions,  26 
Modern  Knowledge,  49 
Morris,  113 
Movable  Kidney,  40 

Neuralgia,  Trigeminal,  35,  109 
Neurasthenia,  34 

Oculocardiac  Reflex,  112 
Oculogastric  Reflex,  63 
O'Donnell,  32,  67,  105 
Ohmmeter,  135 


Osteopathy,  103 
Ovaries,  7,  14,  16 

Painless  Labor,  43,  118 

Palpation,  25 

Pancreatic  Secretion,  116 

Paralysis  Agitans,  119 

Parathyroids,  119 

Pathosphygmography,   142 

Pelvic  Level,  42 

Percussion,  54,   148 

Pertussis,  119 

Photography,  70 

Phthisis,  9 

Pigmentation,  39,  40 

Pleurodynia,  12 

Planck,  110 

Plants,  77,  147 

Polarity,  59,  82,  133,  147 

Polarity,  Sexual,  72 

Polaritherapy,    143 

Poliomyelitis,  34 

"Pop",  103 

Pratt,  65 

Potentiality,  135 

Prediction  of  Sex,  75,  78,  80,  81 

Pregnancy,  80 

Pregnancy,  Vomiting  of,  116 

Pressure,  107,  111 

Prostate,  9 

Pulmonary  Reactions,  137 

Pupillary  Reactions,  142 

Purdue,  41 

Pylorus,  8,  11,  31,  32 

Pylorus,  Reflex,  115 

Rabbits'  Ear,  141 
Radiations,  51 
Radium,  53,  84,  87,  145 
Rate,  Vibratory,  136 
Reactions,  95 

Reactions,  Autoelectronic,  139 
Reactions,  Cardiac,  142 
Reactions,  Electronic,  95,  120 
Reactions,  Multiple,  144 
Reactions,  Potentiality,  135 
Reactions,  Pupillary,  142 
Reactions,  Pulmonary,  137 
Rectocele,  7 

Reflexes,  of  Abrams,   121 
Reflexes,   at   Operation,    106 
Reflexes,  Bladder,  119 
Reflexes,  Intestinal,  32,  105,  116 
Reflexes,  in  Treatment,  104 
Reflexes,  Irritation,  2 
Reflexes,  Liver;  117 


150 


n 


x 


Reflexes,  Lung,  115 
Reflexes,  Miscellaneous,  117 
Reflexes,  Oculocardiac,  112 
Reflexes,  Prostate,  119 
Reflexes,  Spinal,  1 
Reflexes,  Splenic,   117 
Reflexes,  Table,  17 
Reflexes,  Therapeutics,  111 
Reflexes,  Thymus,  119 
Reflexes,  Vasomotor,  118 
Reflexes,  Visceral,  105,  115,  121 
Reflexotherapie,  5 
Rheostat,  135 
Roemer,  29 
Roentgenotherapy,  39 
Roncovieri,   117 
Royal  Touch,  67 
Ryder,  34 

Sawyer,  29 

Selling,  32 

Sex,   Polarity,  72 

Sex,  Prediction,  75,  78,  80,  81 

Sexuality,  Homo,   142 

Sherwood,  107 

Short-circuiting,  126 

Shreiber,  118 

Sinusoidalization,    110 

Smith,  26,  40 

Snow,  105,  114 

Specific  Medication,  145 

Spine,  4 

Spirocheta,  91,  93,  129 

Splanchnic,  Circulation,  113 

Splanchnic,  Neurasthenia,  34 

Splanchnodiagnosis,  122,  124 

Splanchnovascular  Reactions,  122 

Spleen,  128 

Spondylodiagnosis,   21,    108 

Spondylopressor,  69 

Spondylotherapy,  3,  6,  10,  11,  103 

Spondylotherapy,  Electricity  in,  107 

Spondylotherapy,  Methods  of, 

106,  109 

Spondylotherapy,  Review,  103 
Stimulation,  110 


Stomach,  Diseases,  30 
Stomach,  Dilatation,  25 
Stomach,  Reflexes,  31,  54,  57,  115 
Summa,  118 
Symptomatology,  140 
Syphilis,  117,  128,  136,  138,  141,  146 
Syphilis,  Congenital,  128,  144 
Syphilis,  Fournier,  130 
Syphilis,  Optic  Nerve  in,  129 
Syphilis,  Polarity,  78 
Syphilis,  Tests,  90,  93,  128 
Sympathetic  Irritation,  65 
Syphilotherapy,  117 

Tachycardia,  26 

Taylor,  1,  104 

Telediagnosis,  146 

Tenderness,  Vertebral,  15,  17,  108 

Testicles,  77 

Thoughts,  68 

Trigeminal  Neuralgia,  35,  109 

Tubercle  of  Carabelli,  131 

Tuberculosis,  94,  136 

Tuberculosis,  Healed,  136 

Tuberculosis,  Lymph  Gland,  145 

Tuberculosis,  Strains  of,  149 

Upson,  3 
Urea,  28 

Urticaria,  39,  118 
Uterus,  6,  42 

Vagus  Tone,  47 

Vasomotor  Reflex,  109,  118 

Vasomotor,  Diagnosis,  140,  141 

Vaquier,  5 

Vecki,  85,  91 

Vertebra,   Dislocated,   103 

Vertebra,  Tenderness  of, 

4,  13,  17,  108 
Vibration,  58,  106,  145 
Vibratory  Rate,  136 
Vomiting  of  Pregnancy,  116 

Wassermann,  128 


151 


2135   SACRAMENTO  ST. 
SAN  FRANCISCO,  CAL.,  U.  S.  A. 

PHYSICO-CLINICAL  LABORATORY 

— OF — 

Dr.  Albert  Abrams 

FOR  THE  ELECTRONIC  TESTS  OF  ABRAMS 

IMMEDIATE  AND 
ACCURATE  DIAGNOSIS. 

These  tests  permit  of  an  immediate  and  accurate  diagnosis  of  SYPH- 
ILIS, CANCER,  SARCOMA,  TUBERCULOSIS,  TYPHOID  FEVER, 
MALARIA,  PREGNANCY,  GONOCOCCIC  and  STREPTOCOCCIC  IN- 
FECTION, COLISEPSIS  and  other  diseases. 

VIRULENCY   GAUGED 

IN    SYPHILIS     (nervous    system,    cardiovascular    apparatus,    eyes, 

lungs),  and  in  TUBERCULOSIS  (Glands,  lungs,  bone)  the  SPECIFIC 
STRAINS  of  the  organisms  in  these  diseases  may  be  determined,  show- 
ing implication  of  definite  structures  or  the  invasion  of  the  latter  may 
be  predicted.  The  VIRULENCY  of  DISEASE  may  be  GAUGED  with 
MATHEMATICAL  ACCURACY.  Thus,  it  can  be  determined  whether 
SYPHILIS  ("which  never  dies  but  only,  sleeps")  is  active  or  quiescent, 
and  when  treatment  should  be  continued  or  discontinued.  It  is  also 
possible  to  say  whether  SYPHILIS  is  congenital  or  acquired. 

BLOOD  ON  PAPER, 

NO  SPECIAL  INFORMATION  NECESSARY. 

To  execute  these  diagnoses  all  that  is  NECESSARY  is  to  send  sev- 
eral DROPS  OF  BLOOD  from  the  patient  ABSORBED  by  a  CLEAN 
WHITE  BLOTTER  or  filter  paper.  Blood  examinations  only,  do  not 
permit  of  the  localization  of  lesions,  and  to  achieve  the  latter  an  exam- 
ination of  the  patient  is  imperative.  Neoplasms,  sputa  and  other  tis- 
sues are  equally  available  for  diagnosis  by  the  same  tests.  NO  IN- 
FORMATION concerning  the  patients  from  whom  the  blood  is  ob- 
tained is  necessary  (other  than  in  tests  for  pregnancy),  thus,  unlike 
the  laboratory  tests,  the  electronic  tests  permit  an  unprejudiced  opin- 
ion. These  tests  will  be  appreciated  by  your  patients.  To  treat  them 
without  a  correct  diagnosis  is  only  adding  insult  to  injury.  A  diag- 
nosis in  the  usual  way  by  skilled  diagnosticians  shows  50  per  cent,  of 
errors  and  in  some  diseases  75  per  cent. 

A  FEW  REFERENCES 

Full  information  concerning  these  methods  may  be  found  in  "INTER- 
NATIONAL CLINICS"  (Vol.  1,  27th  series),  the  "REFERENCE 
HANDBOOK  OF  THE  MEDICAL  SCIENCES"  (Vol.  VIII,  3rd  edition), 
and  "NEW  CONCEPTS  IN  DIAGNOSIS  AND  TREATMENT"  (Abrams). 
All  the  tests  are  controlled  by  the  "Sphygmopathometer,"  an  instru- 
ment devised  by  Dr.  Albert  Abrams. 

ONLY  ONE  IN  FIVE 

Laboratory  diagnoses  are  notoriously  fallacious.  There  is  only  ONE 
CHANCE  IN  FIVE  that  a  specimen  of  blood  submitted  to  ten  serol- 
ogists  will  result  in  an  agreement.  The  negative  results  with  the  W.as- 
sermann  are  fully  50  per  cent.,  and  positive  reactions  with  this  test  are 
elicited  in  non-syphilitics  (2.6  to  18.1).  Positive  reactions  may  occur  in 
tuberculosis,  acidosis,  malaria  and  other  affections.  Collins  (A.  J.  M.  Sc. 
1916),  estimates  that  15  per  cent,  of  paretics  and  70  per  cent,  of  ce.re- 
brospinal  syphilitics  fail  to  give  a  positive  Wassermann  in  the  spinal 
fluid.  Physicians  of  prominence  no  longer  rely  on  the  Wassermann 
test.  The  same  fate  is  destined  for  the  reactions  of  Abderhalden,  when 
one-third  of  all  MEN  yield  the  test  of  pregnancy! 

NEARLY  100  PER  CENT.  POSITIVE 

Geo.  O.  Jarvis,  A.  B.,  M.  D.  (formerly  of  the  University  of  Pennsyl- 
vania), found  that  the  electronic  tests  of  Abrams  were  POSITIVE  in 
nearly  100  PF.R  CENT,  of  syphilitic  affections  (hereditary  or  acquired). 


VECKI 

"I  have  witnessed  marvelous  results,"  observes  Vecki,  the  noted 
syphilologist  in  his  SEXUAL,  IMPOTENCE  (W.  B.  Saunders  &  Co., 
1915)  "in  the  diagnosis  of  syphilis  by  the  ELECTRONIC  TESTS  OF 
ABRAMS." 

The  tests  embody  the  employment  of  the  visceral  reflexes  of 
Abrams. 

FROM  ENGLAND 

Sir  James  Barr,  in  his  Presidential  address  at  the  18th  annual  meet- 
ing of  the  BRITISH  MEDICAL  ASSOCIATION  (BRITISH  MEDICAL 
JOURNAL,  July  27,  1912),  observes  as  follows: 

"The  versatile  genius  of  Dr.  Albert  Abrams,  w*ho  has  come  all  the 
way  from  San  Francisco  to  do  honor  to  this  meeting  of  the  BRITISH 
MEDICAL  ASSOCIATION,  has  taught  us  how  best  to  cure  intratho- 
racic  aneurysm,  and  has  shed  light  on  the  nature  of  the  cardiac  and 
respiratory  reflexes.  In  the  treatment  of  diseases  of  the  heart  and 
lungs,  his  work  does  great  credit  to  the  new  Continent  and  he  has 
given  us  further  insight  into  methods  of  prevention." 

CANCER 

Prof.  Perdue,  Director  of  the  largest  laboratory  for  cancer  research  in 
America,  observes: 

"Nothing  in  recent  medicine  has  been  so  revolutionary  in  diagnosis  as 
the  reactions  of  Abrams.  For  many  years  the  profession  has  looked  to 
the  laboratory  for  exactness  in  diagnosis,  and  out  literature  has  been 
full  of  the  Wassermann  reaction  and  the  Abderhalden  tests  for  preg- 
nancy and  cancer.  In  the  midst  of  all  this  came  the  diagnostic  me.th- 
ods  of  Abrams.  Methods  so  simple,  so  scientific,  so  exact,  so  prac- 
tical, at  once  made  the  PROCESSES  of  the  LABORATORY  OBSO- 
LETE and  historic  in  medicine.  I  have  NEVER  SEEN  the  reactions 
of  Abrams  fail  or  be  misleading." 

INCIPIENT   TUBERCULOSIS 

Dr.  W.  J.  CAESAR,  Richmond,  Cal.,  observes  as  follows: 
"Like  many  physicians,  I  had  heard  of  but  had  never  investigated 
Abrams'  Electronic  tests.  At  the  solicitation  of  Dr.  W.  R.  Scroggs, 
who  had  studied  the  reactions,  I  was  induced  to  bring  one  of  my  pa- 
tients (a  chronic  neurasthenic?)  to  San  Francisco  for  diagnosis.  To 
my  utter  amazement,  the  diagnosis  made  was  that  of  INCIPIENT 
TUBERCULOSIS,  which  could  never  have  been  demonstrated  by  the 
conventional  methods.  The  results  of  treatment  (rapid  recovery  of  the 
patient  and  weight  increased  from  140  to  171  Ibs.)  by  Dr.  Abrams' 
method  of  polaritherapy,  fully  justified  the  diagnosis.  Since  then,  I 
have  witnessed  the  confirmation  of  many  other  diagnoses  by  the  same 
tests.  I  have  taken  Dr.  Abrams'  course,  and  am  constantly  using  his 
methods  of  diagnosis,  and  I  am  fully  justified  in  saying  that,  were  I 
compelled  to  hark  back  to  the  accepted  methods  of  diagnosis,  I  would 
rather  relinquish  practice  than  to  continue  it." 

DIAGNOSIS  AT  THE  VERT  BEGINNING 

"It  is  many  years  since  the  medical  profession  has  shown  such  in- 
terest in  any  new  discovery  as  they  have  in  Electronic  diagnosis,  first 
discovered  by  Dr.  Albert  Abrams,  of  San  Francisco.  To  be  able  to 
DIAGNOSE  AT  THE  VERY  BEGINNING  tuberculosis,  carcinoma, 
syphilis,  pus  formation,  and  so  on,  and  not  have  to  rely  upon  doubtful 
laboratory  methods,  is  almost  beyond  comprehension  or  belief." — George 
Starr  White  (AMERICAN  JOURNAL  OF  CLINICAL  MEDICINE.) 

In  another  communication  to  the  same  Journal,  George  Starr  White 
observes  as  follows:  "This  same  human  energy  can  be  used  to  diag- 
nose disease  in  its  early  stages  better  than  any  other  known  method. 
To  Dr.  Albert  Abrams  is  due  the  credit  for  this  epoch-making  dis- 
covery. It  is  the  external  counterpart  of  the  Abderhalden  reactions." 

SPECIMENS 

Blood  specimens  should  be  placed  on  a  paper  or  blotter  enclosed  in 
the  specimen  container  or  envelope  and  mailed  immediately.  Examina- 
tion will  be  made  at  once,  and  reported  on  fully  and  promptly.  Fees 
should  accompany  specimens.  Special  correspondence  is  invited,  with  a 
view  to  informing  you  in  detail  about  any  part  of  the  work  of  the 
Laboratory  which  may  not  be  clear  to  you. 


FEES 

(Which  include  all  diagnostic  information  necessary.) 

Blood  examinations  which  include  tests  for  all  diseases $10.00 

Subsequent  blood  examinations  to  gauge   the  course  of  the 

disease 5.00 

Examination  of  patients 25.00 

(With  full  instructions  to  the  physician  for  executing  Abrams'  meth- 
ods of  Electronotherapy.  By  the  latter,  most  uncomplicated  and  inci- 
pient forms  of  tuberculosis  are  amenable  to  symptomatic  cure  within  a 
few  weeks.) 

Course   to   physicians   on  Electric  Diagnosis    $100.00 

(Limited  to  reputable  physicians  in  possession  of  the  M.  D.  degree.) 

STATEMENT  OF  W.  J.  CAESAR,  M.  D. 

"After  taking  Abrams'  course  on  Electronic  Diagnosis  I  am  able 
to  accurately  detect  and  measure  the  virulency  of  tuberculosis,  syphilis 
(and  to  differentiate  the  acquired  from  the  congenital  form  of  the 
latter),  oolisepsis,  streptococcic  infection,  cancer,  sarcoma,  gonorrhea, 
etc.  The  functional  activity  of  the  organs  including  the  ductless 
glands  may  be  mathematically  gauged.  The  topography  of  the  vis- 
cera may  be  accurately  denned.  The  foregoing  has  been  formulated 
after  mature  deliberation  based  on  therapeutic  results  and  corrobor- 
ation  at  the  operating  table." 

Victor  6.  Veckt,  3U.  3D. 

PHYSICIANS1  BUILDING 

516    SUTTER    STREET.  COR.  POWELL 

SAN   FRANCISCO.  CAL. 


June   13th,    1917. 


Albert  At rams,  M.D. 
2135  Sacramento  St., 
San  Francisco,   Cal. 

My  dear  Dr.  Abraias: 

It  conforms  only  with  exact  and  plain 
truth  to  say  that  in  all  cases  submitted 
to  you  for  diagnosis  "by  means  of  your 
electronic  reactions  your  findings  were 
absolutely  correct  and  justified  by 
subsequent  therapeutic  results. 

Sincerely  yours, 


When  I  firet  began  to  investigate  the  subject  of  Electronic 
Diagnosis,  I  found  the  work  moot  confusing  but  further  investiga- 
tions at  the  Physico-Clinieal  Laboratory  of  Dr.  Abrams,  convinced 
me  from  therapeutic  results  observed,  of  the  correctness  of  his 
diagnoses.  It  is  impossible  to  form  a  very  intelligent  opinion  of 
these  methods  from  reading  about  them.  One  must  cone  to  Dr.  Abrams' 
laboratory  and  watch  him  at  his  v;ork  and  hear  his  explanations  and 
comments  and  if  he  approaches  the  investigation  in  an  unprejudiced 
frame  of  mind  the  physician  will  soon  discover  that  he  has  found 
something-  that  rill  be  of  vast  usefulness  to  him  in  his  medical  work. 
I  consider  the  last  five  months  that  I  have  spent  in  this  investira- 
tion  as  the  best  spent  time  of  ny  medical  life  and  would  heartily 
advise  any  of  my  confreres  to  pursue  a  like  course. 


Very  sincerely, 


1st.  Lieut.  Medical  Corps 
U.  S.  Army. 


OR.  HARLEY  E.  MACDONALD 

PHYSICIAN  AND  SURGEON 


1521   So    HOPE  STREET 
LOS  ANGELES    CALIFORNIA 


%/L<<i<y 


DR.  GEOROE  O.  JARVIS 

THE  SANITARIUM 
A8ML.AND,  OREGON        JUH«     15,      1917. 


,The  electronic  reactions   of  Abrams  have  been   intro- 
fcuced   to   the   profession   at   a  time  when   the  electro- chemical 
conception  of  cellular  activity  is  beginning  to  make   its  way. 

Without  a'clear  idea  of  this  electro-physical  con- 
cept of  physiologic  and  pathologic  activities  the  electronic 
reactions  of  Abrams  are  difficult  to  comprehend,  even  thou$i 
comparatively  simple. 

These   reactions  are  based  on   the   facts    (l)    that 
[electro-chemistry   in  normal   tissues  differs  from  that   in   ab- 
normal  tissues;    v2)   that  energy  from  the   tissues  can  be   con- 
ducted along  any  insulated  conductor;    and   (3)    that   the   ganglion 
scells  of  the   spinal   cord,    the  peripheral   ganglia,    or  the 
barenchymatous  cells  themselves   of  the  various  organs  will 
all   respond  to  energy  conducted  from  an   anlage   of   special 
physiologic  activity   (such  as  the  beating  heart)    or  from  an 
anlage   of  pathologic  activity   (such  as  a  cancer  node   or  a 
ifocus  of  infection). 

These   reactions   show  themselves  in  the   organs  by 
Ichange   of  density,    of   shape,    and  of  percussion  note.        Alter- 
lations  in   the  blood  pressure  may  also  be   demonstrated  in  a 
test   subject  if  the  energy  is  conducted  in  an  appropriate 
manner. 

It  is  recognized  that    the   Wasserman   reaction   is 
not  an   entirely   satisfactory   guide   in   the   diagnosis  of 
syphilis  and   that  it   is   especially  unreliable  in   the   diagnosis 
of  recent   and   of   inherited  lues.        The  writer  has  made  positive 
diagnosis   of   syphilis  in   a  number  of  patients  in  whom  the 
"Wasserman  tests  have  been  executed  by   one   or  more  competent 
serologists  and  returned  ae  negative. 

In   some   of   the^recent" cases  the  presence   of  mucous 
patches,    demonstration   of   the  Spirochaetae  pallidee,    and  the 
therapeutic   results  permit    of  no    aoubt   as  to   the   diagnosis. 
In   cases  of  long    standing  and  in   Inherited  infection   demon- 
stration  of  the   Spirochaetae  was  not  made;   but  the  case 
histories,    the  family  histories,    and  the   immediately  beneficial 
results   of   treatment   left  no  reasonable   doubt   as  to   the 
accuracy   of  the  diagnosis   as  made  by   the   electronic   reactions 
of  Abrams. 

Some   of  these  cases  had  been   repeatedly  examined 
by   competent    serologists  at   the   largest   clinice  in   the   country 
and  hud   there  been   treated   for  various  non-existent    diseases; 
this  because   an   accurate  diagnosis  could  not  be  made. 

In   eighteen  cases  in  which  both  Wasserman  and  elec- 
tronic  tests  were  made   there  was  only  one   in   the   electronic 


OR.  QEORQE  O.  JARVIS 

THE   SANITARIUM 
ASHLAND,   OREOON 

-2- 

reaction  which  yielded  a  doubtful  result   and  this  case  had 
teen  examined  by  various  physicians  from  New  York  to  San 
Francisco   and  had  been  treated  for  possible  luetic  in- 
fection,   including  a  sojourn   at  the   Kansas  Hot   Springe. 
A  course  of  neosalvarsan  with  intensive  mercurial  treat- 
ment failed  in  my  hands  to  produce  marked  improvement 
though  there  was  an  amelioration  of  certain   symptoms.        This 
case  was  a  failure  in  diagnosis  both  on   the  part   of  the 
writer  and  upon   the  part   of  a  number  of  eminent   syphilographe 

In   cancer  the  matter  of  diagnosis  is   so  important 
that  authorities  agree   that  a   cancer   subjected   to   early  and 
radical   removal  offers  a  fair  prospect   of  freedom  from   recur- 
rence.       In  external   cancers  it   is  naturally  possible   to  make 
a  diagnosis  earlier  than  if  the   growth  be   located  internally. 
In  gastric  cancers  the   diagnosis  must  await  the   appearance 
of    Ma  cancer  rest";—  but   this  implies  a  fairly  advanced 
carcinoma. 

By  the  electronic   reactions  of  .Abrams  Dr.   A.   W. 
Boslough,    of  Ashland,    Oregon,    and   the   writer  have  been   able 
to  diagnose  eleven  gastric  and  other  internal  cancers  at 
a  time  when   there  was  only  the   smallest  macroscopic   sign  of 
a  cancer  in  the  removed  specimen.        'When   the    specimens  were 
submitted  to  one   or  more  competent  pathologist  s.,    who  had  no 
teiowledge  of  the   case  beyond  the  region  from  which  the 
tissue   was  removed,    they  returned  a  diagnosis   of  malignancy 
with  one   exception.        In   this  case  one  pathologist  pronounced 
it  malignant  and  another  benign;   but   the  recurrence  of 
symptoms  after  operation  and  the   subsequent  death  of  the 
patient   left  no  reasonable   doubt  but  that   the   growth  was 
malignant. 


Specimens   in  which  a  suspicion  of  malignancy/might 
exist,   both  from  the  history  and  from  the  macro  scopiG/appear« 
ance,   but  which  the  reaction   of  Abrams   showed  to  be/benign, 
invariably  proved  on  pathologic  examination   to  be/fton- 
malignant.        The   subsequent   history  of  those  pronfounced  benigr 
have   shown,    so   far  as  the   lapse   of  time  permits/  that  the 
diagnosis   of  a  benign  process  was  justified,     /^he   clinical 
cour&«   of  those   in   which  the  diagnosis   of  malignancy  was  made 
has  shown,   unless   complete  extirpation  was  possible,    the  bes' 
foundation   for  a  diagnosis   of  malignancy. 

In   a   few  of  the   cases  diagnosed  as  cancer  by   the 
electronic  method   the  macroscopic  evidences  of  malignancy 
were   so    slight   that   the  writer  was  strongly  inclined  to   doubt 
the  diagnosis  until  an  examination  of  the   specimen  by   two 
independent   patho  legists  in   different   cities  had  proven  beyond 
cavil  the   presence   of  cancer. 


OR.  GEORGE:  o.  JARVIS 

THE  SANITARIUM 
ASHL.AND,  OREGON 

-3- 


With  regard  to  bacterial  infections;— the  tests  made 
by  the  writer  have  been  largely  upon   teeth,    the   roots  of  which 
were  infected  and  in  which  radiographs  were  made  to   show 
the  possible   existence   of  peri -radical   tissue   changes  possible 
to  demonstrate  by  the  x-ray.       Of  these  there  were  thirty- 
two  cases  in  which  x-ray  plates  were  made,    the  electronic 
test  performed,    and  extraction   with  examination   of  the  ex- 
tracted teeth  done. 

Extractions  of  the   suspected  teeth  proved  the 
accuracy  of  the   diagnosis  of  streptococcic  infection.        It 
cannot  be   said  that  no  cases  went  undiagnosed  because   teeth 
which  yielded  no  reaction  were  not  extracted-       The  subse- 
quent  clinical  history  of  the  cases  of  suspected  focal  in- 
fection  strongly  substantiated  the  findings  of  the  electronic 
method. 

With  regard  to    sarcoma,    the  writer  has  had  but  two 
cases   since  learning  the  method  of  Abrams  and  is  therefore 
unable  to    say  more  than  that  the  reaction  was  positive   and 
correct   in  these  two   instances. 

Of  the  accuracy  and  delicacy  of  this  method  of 
Dr.    Abrams  there  can  be  no   question.        Its  simplicity  leads 
some  to  overlook  the  necessity   for  care  and  accuracy  joined 
to   considerable   study  and  experience.        In  the  hands   of 
those  who   lack  accurate   and  delicate  percussion,    who   are  un- 
able to  distinguish  variations  in  density  of  tissues 
(resistance)   and  percussion   sounds,    or  are  unwilling  to  give 
time   and  labor  to   the   investigation   of  the  methods  and  per"- 
fection   of  the   technique   the   results  will  be  unreli8ble;_gj  ' 
would  be   the   case  with  any  other  diagnostic  procedure^ 

Respectfully, 

tft-  &\.  '  i 


r™"^}^'' 


WARNING 

Many  physicians  have  forwarded  specimens  of  blood  to  the 
Physico-Clinical  Laboratory  for  diagnosis.  Many  of  them 
forget  that  all  things  in  nature  show  radioactivity  and  that 
ro/or  interferes  with  the  splanchnic  reactions.  Specimens  have 
been  received  on  colored  and  on  printed  paper.  These  errors 
must  be  avoided  and  only  white  filtering  paper  or  a  blotter 
(white)  should  be  used  for  the  blood.  While  a  brief  statement 
accompanying  the  specimen  will  be  of  material  aid  in  diagno- 
sis, the  statement  is  not  absolutely  necessary.  Unless  specially 
requested  and  without  comment  from  the  physician,  only  the 
following  conditions  will  be  sought  for:  SYPHILIS,  TUBERCU- 
LOSIS, CANCER,  COLISEPSIS  and  STREPTOCOCOCCIC  INFECTION. 

When  two  blood  specimens  are  sent,  forward  them  in  separ- 
ate envelopes  to  avoid  conferred  radioactivity. 

The  quantity  of  blood  forwarded  should  be  sufficient  to 
cover  an  area  represented  by  a  50  cent  piece. 

No  diagnostic  method  is  infallible.  It  is  requested  that  all 
physicians  correlate  the  electronic  diagnosis  with  their  clinical 
findings. 


Diseases  Diagnosed  by  an  Examination  of 
Dried  Blood 


Acidosis 

Adrenal   Sufficiency 
Amebiasis 
Colisepsis 
Carcinoma 
Cholelithiasis 
Chorea 
Diabetes 
Diphtheria 
Epilepsy 

Gonococcic    infection 
Gout 

Hookworm 
Hyperpituitarism 
Hyperthyroidism 
Influenza 


Pneumococcic  infection 

Psychasthenia 

Pregnancy  (prediction  of  sex) 

Paresis 

Poliomyelitis 

Rheumatoid  arthritis  (variety 

Sarcoma 

Scarlatina 

Staphylococcic    infection 

Streptococcic  infection 

Meningococcic  infection   Syphilis    (differentiation    of 
Neurasthenia  congenital    and    acquired, 

and  specific  strain.) 

Teniasis 


Insanity 

Paranoia 

Dementia  Precox 

Acute  Mania 

Dipsomania 

Chronic  Dementia 
Leprosy 
Malaria 
Measles 
Menstruation 


Paralysis  Agitans 

Parotitis 

Parathyroid  insufficiency TyphoTd 

Paratyphus  Tuberculosis  (varieties) 


The  virulency  of  all  diseases  is  mathematically  measured  and  serves 
as  a  valuable  guide  in  noting  their  progression  or  retrogression  and 
the  efficacy  of  treatment — notably,  syphilis. 

A  personal  examination  of  the  patient  is  necessary  in  estimating  the 
functional  activity  of  the  ductless  glands  and  viscera. 

IMMUNODIAGNOSIS  is  also  capable  of  demonstration  in  some  of 
the  foregoing  diseases.  It  can  be  shown  from  the  blood  whether  the 
subject  possesses  natural  or  acquired  immunity  to  typhoid  fever; 
whether  typhoid  inoculations  are  necessary  or,  if  given  whether  they 
will  prove  effective,  thus  dissipating  any  false  security  against  infec- 
tion. Some  people  show  a  natural  immunity  to  CANCER  and  this  i« 
demonstrable  by  a  blood  examination. 


DATE  DUE 


PRINTED  IN  U    S    A 


WET25 
Al6ls 
1918 
Abrams,  Albert. 

Spondylotherapy  . . . 


WET25 
Al6ls 
1918 
Abrams,  Albert. 

Spondylotherapy  . . . 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
IRVINE,  CA    32664 


